This 5-year follow-up of a two-center RCT compares suture button vs. single quadricortical syndesmotic screw fixation for acute syndesmotic injury. 97 patients were randomized; 84% completed 5-year follow-up. The study asks whether early functional advantages of suture button seen at 2 years are durable, and whether fixation method affects long-term OA development.
Syndesmotic injury affects 15–37% of operatively treated ankle fractures, and post-traumatic OA is common — but prior to long-term RCT data, it was unclear whether fixation method influenced OA risk or whether early functional differences would endure.
This trial establishes that the choice between suture button and screw has consequences beyond the index hospitalization. When you fix an acute syndesmosis, use a suture button: it produces better function at 5 years and cuts the odds of radiographic OA by roughly half.
If your patient also has a medial malleolar fracture, counsel them carefully. That pattern independently triples OA risk regardless of fixation method.
If screw fixation is used, remember that routine screw removal carries a 6% complication rate; the authors suggest a tricortical screw may be preferable to a quadricortical one when screw fixation is chosen, as it allows more dynamic movement and may reduce the need for removal.
This 5-year follow-up of a two-center RCT compares suture button vs. single quadricortical syndesmotic screw fixation for acute syndesmotic injury. 97 patients were randomized; 84% completed 5-year follow-up. The study asks whether early functional advantages of suture button seen at 2 years are durable, and whether fixation method affects long-term OA development.
Syndesmotic injury affects 15–37% of operatively treated ankle fractures, and post-traumatic OA is common — but prior to long-term RCT data, it was unclear whether fixation method influenced OA risk or whether early functional differences would endure.
This trial establishes that the choice between suture button and screw has consequences beyond the index hospitalization. When you fix an acute syndesmosis, use a suture button: it produces better function at 5 years and cuts the odds of radiographic OA by roughly half.
If your patient also has a medial malleolar fracture, counsel them carefully. That pattern independently triples OA risk regardless of fixation method.
If screw fixation is used, remember that routine screw removal carries a 6% complication rate; the authors suggest a tricortical screw may be preferable to a quadricortical one when screw fixation is chosen, as it allows more dynamic movement and may reduce the need for removal.