Suture-endobutton fixation of ankle tibio-fibular diastasis: a cadaver study

Foot Ankle Int. 2003 Feb;24(2):142-6. doi: 10.1177/107110070302400208.


Suture-Endobutton fixation is proposed as a minimally invasive, flexible fixation of ankle tibio-fibular diastasis, which would not require routine removal. This study tested the Suture-Endobutton construct in a cadaver syndesmosis injury model and compared this against A.O. syndesmosis screw fixation. Sixteen embalmed cadaver legs were used. Phase one consisted of placing the leg in a jig, generating an external rotation torque and measuring diastasis with increasing intraosseous membrane division. Phase two then compared the Suture-Endobutton construct vs. single four-cortex 4.5 mm A.O. screw fixation. Diastasis increased significantly with increasing intraosseous membrane division (p<0.001). No significant differences were seen in the mean rate of failure between the Suture-Endobutton and A.O. screw fixation. However, the Suture-Endobutton did give a significantly more consistent performance; the distribution of standard deviations for A.O. screw fixation was 0.64 mm higher than that for the Endobutton (95% C.I. 0.46 to 0.84). These results show that Suture-Endobutton fixation at least equals the performance of screw fixation and encourages clinical trials in ankle injuries with a syndesmosis diastasis.

Publication types

  • Comparative Study

MeSH terms

  • Ankle Injuries / surgery*
  • Ankle Joint / surgery*
  • Bone Screws
  • Cadaver
  • Fibula / surgery
  • Humans
  • Internal Fixators*
  • Ligaments, Articular / injuries
  • Ligaments, Articular / surgery
  • Minimally Invasive Surgical Procedures / instrumentation
  • Minimally Invasive Surgical Procedures / methods
  • Random Allocation
  • Rotation
  • Rupture
  • Suture Techniques*
  • Tibia / surgery