Syndesmosis Fixation

Tyler Nicholson MD

Content Contributor

Evolution of Syndesmosis Fixation

Syndesmosis fixation can be performed for those injuries indicated to undergo operative intervention. There are multiple methods of syndesmotic fixation to include both screw fixation as well as fixation with a suture button or tension wire construct. At this time there is no definitive evidence that either method is superior to the other. When screw fixation is utilized, a 3.5-4.5mm screw is placed across the tibio-fibular joint, essentially reinforcing their syndesmosis.

Typically, 2 screws are utilized, and they placed through both bones of the lower leg. An alternative is suture button or tension wire technology which accomplishes the same goal of re-enforcing the syndesmosis. In this technique, instead of utilizing screws, the surgeon uses a high-tension wire which spans the joint and is fixed to the bone on either side with a small button or some other method of fixation.

Technology Spotlight

Smith and Nephew Invisiknot Syndesmosis Repair Kit

The Invisiknot Ankle Syndesmosis Repair KitTM from Smith and Nephew is an innovative system designed for syndesmosis repair in the setting of an ankle fracture or fracture of the distal fibula, or for isolated syndesmotic injuries. The system is designed to eliminate complications associated with rigid screw fixation. Invisiknot is comprised of a suture tape/button construct which includes two stainless steel buttons, one medial or at the inner ankle, and one lateral at the outer ankle. These buttons are connected by ULTRATAPE suture which is a patented braided cord suture. The system is designed to allow for easy reduction of the displaced syndesmosis and tibio-fibular joint with a one-way sliding knot. Additionally, the lateral button is designed to fit perfectly within the 3.5mm holes of a Smith and Nephew distal fibula plate which could be utilized to fix an associated ankle fracture. This design allows for micromotion between the tibia and fibula which again attempts to eliminate some of the complications that are often seen with rigid screw fixation, primarily hardware failure or screw breakage.