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ORIGINAL ARTICLE •ANKLE - FRACTURES
Tightrope fixation of syndesmotic injuries in Weber C ankle
fractures: a multicentre case series
Amarjit Anand
1
•Ran Wei
2
•Akash Patel
1
•Vikas Vedi
3
•Garth Allardice
4
•
Bobby Singh Anand
2,5
Received: 20 June 2016 / Accepted: 3 November 2016 / Published online: 10 January 2017
Springer-Verlag France 2017
Abstract
Background No general consensus has yet been estab-
lished for the gold standard treatment of ankle syndesmotic
complex injuries. Recent literature has documented the
success of ankle tightrope fixation for heterogeneous ankle
fracture patterns, resulting in syndesmotic complex inju-
ries. We present a multicentre case series assessing the
clinical, radiological and functional outcomes of patients
with Weber C ankle fractures treated with the Arthrex
TightRope
fixation system.
Method We performed a retrospective analysis of all adult
patients with Weber C ankle fractures who were treated
with the Arthrex TightRope
fixation system at four cen-
tres over a 3-year period. All patients were followed up for
a mean of 14 months (range 12–26). Outcomes measures
were assessed subjectively using functional scores
(AOFAS and Olerud and Molander) and objectively using
radiological measurements, complication rates and revision
surgery rates.
Results Thirty-six patients met our eligibility criteria.
The mean age at operation was 31 years (range 18–65).
There were 20 males and 16 females. No patients were
lost to follow-up. The ankle tightrope maintained satis-
factory reduction in the ankle mortise in 97% of cases.
Of these 35 successfully treated cases, no evidence of re-
displacement on follow-up radiographs of the syn-
desmotic complex was observed at an average of
10.8 months (range 6–12). Post-operative mean medial
clear space was 3.1 mm, and mean tibio-fibular overlap
was 10.1 mm. The mean American Orthopaedic Foot
and Ankle Society (AOFAS) score was 88.8 (range
67–98) at a mean follow-up of 14 months (range 12–26).
The overall complication rate was 6% (one failure
requiring revision surgery and one medial sided skin
irritation requiring removal of suture button). No infec-
tions or wound complications occurred.
Conclusion Tightrope fixation is a safe alternative to screw
fixation for syndesmotic complex injuries in Weber C
ankle fractures. We have shown that it has low complica-
tion rates and a high patient satisfaction.
Keywords Ankle Fractures Tightrope Weber C
Syndesmosis Syndesmotic complex Syndesmosis
repair Syndesmosis reconstruction Syndesmosis
reduction Diastasis Suture button
&Bobby Singh Anand
bobby.anand2@nhs.net
Amarjit Anand
amarjitanand@gmail.com
Ran Wei
ranwei@nhs.net
Akash Patel
mrakashpatel@doctors.org.uk
Vikas Vedi
Vikas.Vedi@thh.nhs.uk
Garth Allardice
garthvon@btinternet.com
1
Imperial College London Hospitals, London, UK
2
Croydon University Hospital, 530 London Road,
Surrey CR7 7YE, UK
3
Hillingdon and Mount Vernon Hospital, London, UK
4
Northwick Park Hospital, Watford Road,
Harrow, Middlesex HA1 3UJ, UK
5
The Elective Orthopaedic Centre, Dorking Road,
Epsom KT18 7EG, UK
123
Eur J Orthop Surg Traumatol (2017) 27:461–467
DOI 10.1007/s00590-016-1882-8
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