Biomechanical evaluation of syndesmotic fixation techniques via finite element analysis: Screw vs. suture button

Tibiofibular syndesmotic injuries may cause degenerative changes, reduction in ankle function and compromising stability. Different fixation techniques try to restore its functionality. Screw-fixation is the gold-standard. Recently, suture-button has aroused attention because it allows for physiologic micromotion while maintaining an accurate reduction. The aim of this study compare biomechanical behaviour both using finite element method. A three-dimensional model tibiofibular joint was reconstructed simulating intact injured syndesmosis. Then, different methods syndesmosis were analysed: screws (number cortices, number distance between screws) suture buttons (single, double parallel divergent with a sensitivity analysis on pretension forces) configuration. Ligaments cartilages included simulated as spring elements. Physiological loads during stance phase simulated. Syndesmosis widening von Mises stresses computed. configuration compromised stability (2.06 mm), whereas single quadricortical screw (0.18 mm) stiffened joint. suture-buttons closer (0.97 mm). Von higher titanium than buttons. detailed comparison among performed. Suture have advantages regard fixation. This fact supports good long-term clinical results obtained proposed methodology could be efficient tool preoperative planning.