Suture Button Fixation for Syndesmosis Injuries: Review of the Literature

Syndesmosis injuries -also known as high ankle sprainshave an increasing popularity because of an increased awareness of diagnosis. Different from lateral ankle sprains, mechanism of injury mostly involves external rotation, eversion and excessive dorsiflexion. Other mechanisms can also cause sydesmosis injuries. Because of high levels of missed injuries the real prevalence of syndesmosis injuries is underestimated. It is less frequently seen than lateral ankle injuries. For diagnosis, physical and radiological examination is essential. In radiological examination, associated injuries must be determined if present. Mostly seen associated injury is ankle fracture. Nonoperative treatment provides good results for syndesmosis injuries. Surgical treatment is indicated when syndesmosis injuries include frank diastasis. Arthroscopic view of syndesmotic instability is another indication. Failed conservative treatment may also be an indication. There are a lot of options for surgical fixation. Screws are the most popular among others but there are some complications about them. Alternatively, suture button fixation technique can be used. Suture button fixation is an implant with two metallic buttons surrounded with thick fiberwire sutures. Its stabilization mechanism depends on compression of two buttons to opposite sites by the help of fiberwire. It is designed to resist diastasis but allows small movement to other planes. It is very suitable for fixation of syndesmosis injuries and also to have less complication rates. Purpose of this study is to discuss the syndesmotic injuries and review the suture button fixation technique for the treatment.