A Novel Flexible Fixation Method for Syndesmotic Injury

Foot Ankle Int. 2023 Sep;44(9):854-861. doi: 10.1177/10711007231177044. Epub 2023 Jun 17.


Background: This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the "embrace" technique.

Methods: Between March 2018 and October 2020, a total of 67 patients with ankle fractures and syndesmotic injuries underwent syndesmosis fixation with the embrace technique at our institute. Plain radiographs and computed tomographic (CT) scans were obtained preoperatively. Postoperative radiographic assessment included anteroposterior (AP) and lateral radiographs and CT scans of both ankles. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Olerud-Molander Ankle Score, and visual analog scale (VAS) score were used for postoperative assessment.

Results: The mean age was 27.6 ± 10.9 (range, 14-56) years. The mean follow-up time was 30.3 ± 6.2 (range, 24-48) months. There were no malreductions indicated by any CT parameter except fibular rotation in a postoperative comparison between 2 sides. We found significant preoperative-postoperative changes in anterior difference, posterior difference, and fibular rotation but no significant preoperative-postoperative difference in fibular translation. There was no significant postoperative difference between the affected-side and normal-side measurements of any parameter. Complications included delayed wound healing, lateral pain because of wire knot irritation (11.9%), and medial fiber wire irritation (7.5%). The mean AOFAS, Olerud-Molander, and VAS scores at the last follow-up were 94.4 ± 6.8 (range, 84-100), 95.4 ± 6.1 (range, 80-100), and 0.68 ± 1.0 (range, 0-3) points, respectively.

Conclusion: In our cohort, this novel technique proved to be an effective method for syndesmosis fixation in patients with ankle fractures associated with very good radiologic and patient-reported outcomes.

Level of evidence: Level IV, case series.

Keywords: ankle fracture; dynamic fixation; embrace technique; postoperative CT; syndesmosis.

Publication types

  • Comment

MeSH terms

  • Adolescent
  • Adult
  • Ankle
  • Ankle Fractures* / diagnostic imaging
  • Ankle Fractures* / surgery
  • Ankle Injuries* / diagnostic imaging
  • Ankle Injuries* / surgery
  • Ankle Joint / diagnostic imaging
  • Ankle Joint / surgery
  • Bone Screws
  • Fracture Fixation, Internal / methods
  • Humans
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult