{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T12:22:17Z","timestamp":1778070137750,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Several techniques to treat acute distal tibiofibular instability are described consisting in static and dynamic fixation procedures. The aim of our work is to compare the outcomes of acute syndesmotic injury fixation between the modified technique of dynamic fixation using the suture-button principle as an efficient and low-cost method and the classic static fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>It is a prospective study including patients presenting with acute syndesmotic injury. After fracture fixation, residual syndesmotic instability was managed using syndesmotic screw in group A and dynamic fixation with a double Ethibond suture in group B. Functional results were assessed using the American Orthopaedic Foot and Ankle Society score (AOFAS) score. Radiological evaluation was done by a postoperative computed tomography (CT) scan of both ankles and plain X-rays of the ankle after surgery and at 18 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Group A included 20 patients meanwhile 35 patients were in group B. The reduction was satisfactory in the 2 groups according to the postoperative CT scan measurements. The mean healing time in group A was 49.65 days and 51.49 days in group B (P = .45). We did not find any significant difference in terms of loss of reduction in the 2 groups. The return to work was faster in group B (P = .04). Patients in group B had better AOFAS score (P = .03) and ankle range of motion than those in group A. The difference was statistically significant (P = .02 for dorsal flexion and P = .001 for plantar flexion). For group A, we did not note any early complications. Meanwhile, 7 patients developed skin complications in group B (P = .03). However, no significant difference was found in terms of late complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The modified dynamic suture-button fixation remains a therapeutic alternative in low-income countries that could achieve better outcomes than static fixation, with easy postoperative follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Levels of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Level II<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19386400241256440","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T08:37:08Z","timestamp":1717058228000},"page":"241-253","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Study for Surgical Treatment of Acute Distal Tibiofibular Syndesmotic Lesions Using the Modified Suture-Button Fixation Versus Static Syndesmotic Screw Fixation"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8862-2722","authenticated-orcid":false,"given":"Mohamed","family":"Jlidi","sequence":"first","affiliation":[{"name":"Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia"},{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walid","family":"Bouaicha","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia"},{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siwar","family":"Sbaihi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia"},{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hedi","family":"Gharbi","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mouldi","family":"Lamouchi","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia"},{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim","family":"Mallek","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salma","family":"Jaziri","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, Kef, Tunisia"},{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selim","family":"Daas","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia"},{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2006.2195"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2019.09.014"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.47B4.634"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2009.03.011"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-010-1147-9"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.02.003"},{"issue":"6","key":"e_1_3_2_8_2","article-title":"Removal of syndesmotic screw after fixation in ankle fractures: a systematic review","volume":"13","author":"Desouky O","unstructured":"Desouky O, Elseby A, Ghalab AH. Removal of syndesmotic screw after fixation in ankle fractures: a systematic review. Cureus;13(6):e15435.","journal-title":"Cureus"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118804204"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1645-7"},{"issue":"138","key":"e_1_3_2_11_2","first-page":"111","article-title":"Evaluation of ankle fractures: non-operative and operative treatment","volume":"1979","author":"Hughes JL","unstructured":"Hughes JL, Weber H, Willenegger H, Kuner EH. Evaluation of ankle fractures: non-operative and operative treatment. Clin Orthop Relat Res. 1979(138):111-119.","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.05.013"},{"issue":"3","key":"e_1_3_2_13_2","first-page":"365","article-title":"Management of distal tibio-fibular syndesmotic injuries: a snapshot of current practice","volume":"74","author":"Monga P","year":"2008","unstructured":"Monga P, Kumar A, Simons A, Panikker V. Management of distal tibio-fibular syndesmotic injuries: a snapshot of current practice. Acta Orthop Belg. 2008;74(3):365-369.","journal-title":"Acta Orthop Belg"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2005.08.016"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01287"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/24730114241232979"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000161090.86162.19"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079501600304"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079301400805"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e318284785a"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-009-0809-4"},{"issue":"118","key":"e_1_3_2_22_2","first-page":"76","article-title":"Dynamic fibular function: a new concept","volume":"1976","author":"Scranton PE","unstructured":"Scranton PEJr, McMaster JG, Kelly E. Dynamic fibular function: a new concept. Clin Orthop Relat Res. 1976(118):76-81.","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-200604000-00006"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231152484"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-012-1500-2"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2008.0049"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2009.0346"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-199901000-00009"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jisako.2021.10.005"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000151845.75230.a0"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2011.10.002"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000245"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.02.004"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2021.07.009"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/19386400231174829"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2022.12.003"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716661221"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2021.06.025"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20161229-02"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2009.05.008"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2011.0908"},{"issue":"4","key":"e_1_3_2_42_2","first-page":"35688","article-title":"Outcomes after unstable fractures of the ankle: what\u2019s new? A systematic review","volume":"14","author":"Monestier L","year":"2022","unstructured":"Monestier L, Riva G, Coda Zabetta L, Surace MF. Outcomes after unstable fractures of the ankle: what\u2019s new? A systematic review. Orthop Rev (Pavia). 2022;14(4):35688.","journal-title":"Orthop Rev (Pavia)"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1177\/24730114211061405"}],"container-title":["Foot &amp; Ankle Specialist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19386400241256440","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19386400241256440","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19386400241256440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T12:02:08Z","timestamp":1778068928000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19386400241256440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,30]]},"references-count":42,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1177\/19386400241256440"],"URL":"https:\/\/doi.org\/10.1177\/19386400241256440","relation":{},"ISSN":["1938-6400","1938-7636"],"issn-type":[{"value":"1938-6400","type":"print"},{"value":"1938-7636","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,30]]}}}