{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T01:47:30Z","timestamp":1776736050805,"version":"3.51.2"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Sohag University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Management of syndesmotic injuries with screw fixation has potential disadvantages, which may lead to the loss of some of the ankle functions. The use of the suture-button system instead can overcome these disadvantages.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Patients and methods<\/jats:title>\n                <jats:p>In a prospective study, 32 patients with acute isolated syndesmotic injuries were treated with a suture-button device. Follow-up was for a minimum of 2 years, regarding the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, patient satisfaction at 3, 12, and 24 months, and radiological assessment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Result<\/jats:title>\n                <jats:p>A significant improvement regarding pain (VAS during rest 5.6 and during walking 6.1 preoperative improved to 0.1 and 0.2 postoperatively, respectively. (<jats:italic>P<\/jats:italic> values were &lt;\u20090.0001 for both pain during rest and walking) and AOFAS score (improved significantly from 44\u2009\u00b1\u20097.5 pre- to 99\u2009\u00b1\u20098.7 points postoperatively (<jats:italic>P<\/jats:italic> value was 0.0034). The improved VAS and AOFAS scores of the repaired ankles gradually reached the values of the contralateral uninjured ankle (evaluated at 3,12, and 24 months, postoperatively). Radiographs and CT of both ankles - repaired and healthy ankles - were similar at the 3 months follow-up. Early full weight-bearing and early return to work and sport characterized all patients. There was no need for hardware removal.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Suture-button treatment for acute isolated ankle syndesmotic injuries leads to favorable clinical and radiological outcomes. Postoperative radiographs and CT denoted maintained ankle stability. Patients can do early full weight-bearing and early return to work and sport.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12891-024-07849-5","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T04:01:47Z","timestamp":1727928107000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Outcome of flexible fixation for acute isolated syndesmotic injuries"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1090-1008","authenticated-orcid":false,"given":"Hossam","family":"El-Azab","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdel Rhman","family":"Hafez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed A.","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moustafa","family":"Elsayed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,3]]},"reference":[{"key":"7849_CR1","doi-asserted-by":"publisher","unstructured":"Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle, (in eng), Foot & Ankle. Jun 1990;10(6):325\u201330. https:\/\/doi.org\/10.1177\/107110079001000607","DOI":"10.1177\/107110079001000607"},{"key":"7849_CR2","doi-asserted-by":"publisher","unstructured":"McCollum GA, van den Bekerom MP, Kerkhoffs GM, Calder JD, van Dijk CN. Syndesmosis and deltoid ligament injuries in the athlete, (in eng). Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA Jun 2013;21(6):1328\u201337. https:\/\/doi.org\/10.1007\/s00167-012-2205-1","DOI":"10.1007\/s00167-012-2205-1"},{"key":"7849_CR3","doi-asserted-by":"publisher","unstructured":"Del Buono A, Florio A, Boccanera MS, Maffulli N. Syndesmosis injuries of the ankle, (in eng). Curr Rev Musculoskeletal Med. Dec 2013;6(4):313\u20139. https:\/\/doi.org\/10.1007\/s12178-013-9183-x","DOI":"10.1007\/s12178-013-9183-x"},{"key":"7849_CR4","doi-asserted-by":"publisher","unstructured":"Corte-Real N, Caetano J. Ankle and syndesmosis instability: consensus and controversies, (in eng). EFORT Open Rev. Jun 2021;6(6):420\u201331. https:\/\/doi.org\/10.1302\/2058-5241.6.210017.","DOI":"10.1302\/2058-5241.6.210017"},{"key":"7849_CR5","doi-asserted-by":"publisher","unstructured":"Pang EQ, Bedigrew K, Palanca A, Behn AW, Hunt KJ, Chou L. Ankle joint contact loads and displacement in syndesmosis injuries repaired with Tightropes compared to screw fixation in a static model, (in eng). Injury. Nov 2019;50(11):1901\u20131907. https:\/\/doi.org\/10.1016\/j.injury.2019.09.012","DOI":"10.1016\/j.injury.2019.09.012"},{"key":"7849_CR6","doi-asserted-by":"publisher","unstructured":"Grassi A et al. Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and Reoperations as Compared With Screw Fixation: A Meta-analysis of Randomized Controlled Trials, (in eng). Am J Sports Med. Jun 12 2019;363546519849909. https:\/\/doi.org\/10.1177\/0363546519849909","DOI":"10.1177\/0363546519849909"},{"key":"7849_CR7","doi-asserted-by":"publisher","unstructured":"Sanders D, Schneider P, Taylor M, Tieszer C, Lawendy AR. Improved reduction of the tibiofibular syndesmosis with tightrope compared with screw fixation: Results of a randomized controlled study, (in eng). J Orthopaedic Trauma. Nov 2019;33(11):531\u20137. https:\/\/doi.org\/10.1097\/bot.0000000000001559","DOI":"10.1097\/bot.0000000000001559"},{"key":"7849_CR8","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1097\/01.blo.0000151845.75230.a0","volume":"431","author":"B Thornes","year":"2005","unstructured":"Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005;431:207\u201312. Feb.","journal-title":"Clin Orthop Relat Res"},{"key":"7849_CR9","doi-asserted-by":"publisher","unstructured":"Andersen MR, Frihagen F, Hellund JC, Madsen JE, Figved W. Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury, (in eng). J Bone Joint Surg. Am vol. Jan 3 2018;100(1):2\u201312. https:\/\/doi.org\/10.2106\/jbjs.16.01011","DOI":"10.2106\/jbjs.16.01011"},{"issue":"4","key":"7849_CR10","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1177\/1071100719898181","volume":"41","author":"AR Wood","year":"2020","unstructured":"Wood AR, Arshad SA, Kim H, Stewart D. Kinematic analysis of combined suture-button and suture anchor augment constructs for ankle syndesmosis injuries. Foot Ankle Int. 2020;41(4):463\u201372.","journal-title":"Foot Ankle Int"},{"key":"7849_CR11","doi-asserted-by":"publisher","first-page":"50","DOI":"10.4103\/abr.abr_66_19","volume":"8","author":"F Amouzadeh Omrani","year":"2019","unstructured":"Amouzadeh Omrani F, Kazemian G, Salimi S. Evaluation of syndesmosis reduction after removal syndesmosis screw in ankle fracture with syndesmosis injury. Adv Biomedical Res. 2019;8:50. https:\/\/doi.org\/10.4103\/abr.abr_66_19. (in eng).","journal-title":"Adv Biomedical Res"},{"key":"7849_CR12","doi-asserted-by":"publisher","unstructured":"Jenkinson RJ, Sanders DW, Macleod MD, Domonkos A, Lydestadt J. Intraoperative diagnosis of syndesmosis injuries in external rotation ankle fractures, (in eng). J Orthop Trauma. Oct 2005;19(9):604\u20139. https:\/\/doi.org\/10.1097\/01.bot.0000177114.13263.12.","DOI":"10.1097\/01.bot.0000177114.13263.12"},{"key":"7849_CR13","doi-asserted-by":"publisher","unstructured":"Qiu HB, Jiang J, Porter D. A new intraoperative syndesmosis instability classification system: Utility and medium-term results in closed displaced ankle fractures, (in eng). Orthopaedic Surg. Nov 2017;9(4):365\u201371. https:\/\/doi.org\/10.1111\/os.12355","DOI":"10.1111\/os.12355"},{"key":"7849_CR14","doi-asserted-by":"publisher","unstructured":"Hallbauer J, et al. Objective assessment of syndesmosis stability using the Hook Test, (in eng). J Clin Med. Jul 10 2023;12(14). https:\/\/doi.org\/10.3390\/jcm12144580.","DOI":"10.3390\/jcm12144580"},{"issue":"1","key":"7849_CR15","doi-asserted-by":"publisher","first-page":"354","DOI":"10.2484\/rcr.v5i1.354","volume":"5","author":"JM Petscavage","year":"2015","unstructured":"Petscavage JM, Perez F, Khorashadi L, Richardson ML. Tightrope walking: a new technique in ankle syndesmosis fixation. Radiol Case Rep. 2015;5(1):354. https:\/\/doi.org\/10.2484\/rcr.v5i1.354. eCollection 2010.","journal-title":"Radiol Case Rep"},{"key":"7849_CR16","volume-title":"978-3-13-244473-7)","author":"MC Buckley","year":"2017","unstructured":"Buckley MC. Apivatthakakul T AO principles of fracture management. (no. 978-3-13-244473-7). Stuttgart, New York: George Thieme; 2017."},{"key":"7849_CR17","doi-asserted-by":"publisher","unstructured":"Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes, (in eng). Foot & Ankle International. Jul 1994;15:349\u2009\u2013\u200953. https:\/\/doi.org\/10.1177\/107110079401500701.","DOI":"10.1177\/107110079401500701"},{"key":"7849_CR18","doi-asserted-by":"publisher","unstructured":"Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales, (in eng). J foot Ankle Surgery: Official Publication Am Coll Foot Ankle Surg. Mar-Apr 2007;46(2):65\u201374. https:\/\/doi.org\/10.1053\/j.jfas.2006.12.002.","DOI":"10.1053\/j.jfas.2006.12.002"},{"issue":"4","key":"7849_CR19","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1053\/j.jfas.2017.02.010","volume":"56","author":"MA Imam","year":"2017","unstructured":"Imam MA, Matthana A, Kim JW, Nabil M. A 24-Month Follow-Up of a Custom-Made Suture-Button Assembly for Syndesmotic injuries of the ankle, (in eng). J Foot Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons. Jul-Aug. 2017;56(4):744\u20137. https:\/\/doi.org\/10.1053\/j.jfas.2017.02.010.","journal-title":"Jul-Aug"},{"key":"7849_CR20","doi-asserted-by":"publisher","unstructured":"Kortekangas T et al. A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography, (in eng). Injury 2015;46(6):1119\u201326. https:\/\/doi.org\/10.1016\/j.injury.2015.02.004","DOI":"10.1016\/j.injury.2015.02.004"},{"key":"7849_CR21","doi-asserted-by":"publisher","unstructured":"Kimura S et al. Changes in the syndesmotic reduction after syndesmotic suture-button fixation for ankle malleolar fractures: 1-Year longitudinal evaluations using computed tomography, (in eng). Foot & Ankle Int. Oct 2021;42(10):1270\u20131276. https:\/\/doi.org\/10.1177\/10711007211008518","DOI":"10.1177\/10711007211008518"},{"key":"7849_CR22","doi-asserted-by":"publisher","unstructured":"Peterson KS, Chapman WD, Hyer CF, Berlet GC. Maintenance of reduction with suture button fixation devices for ankle syndesmosis repair, (in eng). Foot & Ankle Int. Jun 2015;36(6):679\u2009\u2013\u200984. https:\/\/doi.org\/10.1177\/1071100715571631","DOI":"10.1177\/1071100715571631"},{"key":"7849_CR23","doi-asserted-by":"publisher","unstructured":"Colcuc C et al. Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device, (in eng). Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA. Oct 2018;26(10): 3156\u20133164. https:\/\/doi.org\/10.1007\/s00167-017-4820-3","DOI":"10.1007\/s00167-017-4820-3"},{"key":"7849_CR24","doi-asserted-by":"publisher","unstructured":"Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction, (in eng). The Am J Sports Med Dec 2012;40(12):2828\u201335.https:\/\/doi.org\/10.1177\/0363546512461480","DOI":"10.1177\/0363546512461480"},{"key":"7849_CR25","doi-asserted-by":"publisher","unstructured":"Zhang P, Liang Y, He J, Fang Y, Chen P, Wang J. A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury, (in eng). BMC Musculoskeletal Disorders. Jul 4 2017;18(1):286. https:\/\/doi.org\/10.1186\/s12891-017-1645-7","DOI":"10.1186\/s12891-017-1645-7"},{"key":"7849_CR26","doi-asserted-by":"publisher","unstructured":"Pohlemann T et al. Dynamic locking screw improves fixation strength in osteoporotic bone: an in vitro study on an artificial bone model, (in eng). International Orthopaedics. Apr 2015;39(4):761\u20138. https:\/\/doi.org\/10.1007\/s00264-014-2658-6","DOI":"10.1007\/s00264-014-2658-6"},{"key":"7849_CR27","doi-asserted-by":"publisher","unstructured":"Klitzman R, Zhao H, Zhang LQ, Strohmeyer G, Vora A. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis, (in eng). Foot & Ankle International. Jan 2010;31(1):69\u201375. https:\/\/doi.org\/10.3113\/fai.2010.0069","DOI":"10.3113\/fai.2010.0069"},{"issue":"1","key":"7849_CR28","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1053\/j.jfas.2021.07.009","volume":"61","author":"Y Xu","year":"2022","unstructured":"Xu Y, et al. The clinical efficacy of suture-button fixation and trans-syndesmotic screw fixation in the treatment of Ankle Fracture Combined with Distal Tibiofibular Syndesmosis Injury: a retrospective study, (in eng). J Foot Ankle Surg: Off Publication Am College Foot Ankle Surgeons. Jan-Feb. 2022;61(1):143\u20138. https:\/\/doi.org\/10.1053\/j.jfas.2021.07.009.","journal-title":"Jan-Feb"},{"key":"7849_CR29","doi-asserted-by":"publisher","unstructured":"Ramsey DC, Friess DM. Cost-Effectiveness Analysis of Syndesmotic Screw Versus Suture Button Fixation in Tibiofibular Syndesmotic Injuries, (in eng). J Orthopaedic Trauma Jun 2018;32(6):e198\u2013e203. https:\/\/doi.org\/10.1097\/bot.0000000000001150","DOI":"10.1097\/bot.0000000000001150"},{"key":"7849_CR30","doi-asserted-by":"publisher","unstructured":"Neary KC, Mormino MA, Wang H. Suture Button Fixation Versus Syndesmotic Screws in Supination-External Rotation Type 4 Injuries: A Cost-Effectiveness Analysis, (in eng). Am J Sports Med. Jan 2017;45(1):210\u2013217. https:\/\/doi.org\/10.1177\/0363546516664713","DOI":"10.1177\/0363546516664713"},{"key":"7849_CR31","unstructured":"A. I. M J, Holton AN, Hassan, Matthana A. A Novel Suture Button Construct for Acute Ankle Syndesmotic Injuries; A Prospective Clinical and Radiological Analysis, (in eng). The Archives Bone Joint Surg. May 2018;6(3):189\u2013195."},{"key":"7849_CR32","doi-asserted-by":"publisher","unstructured":"Storey P, Gadd RJ, Blundell C, Davies MB. Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique, (in eng). Foot & Ankle International. Sep 2012;33(9):717\u2009\u2013\u200921. https:\/\/doi.org\/10.3113\/fai.2012.0717","DOI":"10.3113\/fai.2012.0717"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-024-07849-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-024-07849-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-024-07849-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T04:01:52Z","timestamp":1727928112000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-024-07849-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,3]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["7849"],"URL":"https:\/\/doi.org\/10.1186\/s12891-024-07849-5","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,3]]},"assertion":[{"value":"27 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 September 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was reviewed and approved by the local ethics committee of Sohag University, Faculty of Medicine on 08.03.2018.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"To participate and to publish was collected from every patient before participation.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"780"}}