SHORT-TERM EFFECTIVENESS OF TightRope SYSTEM FOR TREATMENT OF SYNDESMOTIC TIBIOFIBULAR DIASTASIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LIYanwei , HONGHaisen , LIUHui , DINGZhenqi

Department of Orthopedics, Xiamen University Affiliated Southeast Hospital, Zhangzhou Fujian, 363000, P. R. China;

Corresponding author：

LIYanwei, Email: 16283682@qq.com

Keywords：

Syndesmotic tibiofibular diastasis; Ankle; Dislocation; TightRope

DOI：

10.7507/1002-1892.20160197

Video：

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Objective To summarize the short-term effectiveness of TightRope system for the treatment of syndesmotic tibiofibular diastasis. Methods Between June 2013 and June 2015, 23 patients with syndesmotic tibiofibular diastasis were treated by TightRope system, including 15 males and 8 females with an average age of 32.3 years (range, 16-63 years). Injury was caused by sports in 13 cases, by traffic accident in 6 cases, and by falling from height in 4 cases. The locations were the left side in 13 cases and the right side in 10 cases. The time from injury to operation was 6 hours to 12 days (mean, 3.8 days). According to Lauge-Hansen classification, 13 cases were rated as supination-external rotation type, 7 cases as pronation-abduction type, and 3 cases as pronation-external rotation type; according to Weber classification, 5 cases were rated as type A, 11 cases as type B, and 7 cases as type C. Results The mean operative time was 68.1 minutes (range, 48-93 minutes); the mean intraoperative blood loss was 70.3 mL (range, 20-150 mL); and the mean hospitalization days were 7 days (range, 5-13 days). Superficial local skin necrosis occurred in 6 cases, and primary healing of incision was obtained in the others. All patients were followed up 8-30 months (mean, 16.4 months). X-ray films showed bone union was achieved within 6-12 weeks (mean, 9.4 weeks). No related complications of reduction failure and re-fracture occurred. The internal fixators were removed at 10-18 months postoperatively (mean, 13.3 months). According to American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle function evaluation, the results were excellent in 19 cases and good in 4 cases at last follow-up. Conclusion TightRope system is a good method to treat syndesmotic tibiofibular diastasis, because of safety, convenient operation, and satisfactory short-term effectiveness.

Citation： LIYanwei, HONGHaisen, LIUHui, DINGZhenqi. SHORT-TERM EFFECTIVENESS OF TightRope SYSTEM FOR TREATMENT OF SYNDESMOTIC TIBIOFIBULAR DIASTASIS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(8): 971-974. doi: 10.7507/1002-1892.20160197 Copy

1.	Van Son MA, De Vries J, Roukema JA, et al. Health status, healthrelated quality of life, and quality of life following ankle fractures:a systematic re view. Injury, 2013, 44(11):1391-1402.
2.	Egol KA, Pahk B, Walsh M, et al. Outcome after unstable ankle fracture:effect of syndesmotic stabilization. J Orthop Trauma, 2010, 24(1):7-11.
3.	Stein G, Eichler C, Ettmann L, et al. Tibiofibular screw fixation for syndesmotic ruptures:a biomechanical analysis. Surg Radiol Anat, 2012, 34(7):593-597.
4.	Wang C, Ma X, Wang X, et al. Internal fixation of distal tibiofibular syndesmotic injuries:a systematic review with meta-analysis. Int Orthop, 2013, 37(9):1755-1763.
5.	Rigby RB, Cottom JM. Does the Arthrex TightRope^® provide maintenance of the distal tibiofibular syndesmosis? A 2-year followup of 64 TightRope^® in 37 patients. J Foot Ankle Surg, 2013, 52(5): 563-567.
6.	Wang L, Wang B, Xu G, et al. Biomechanical comparison of bionic, screw and Endobutton fixation in the treatment of tibiofibular syndesmosis injuries. Int Orthop, 2016, 40(2):307-314.
7.	林昂如, 邹和荣, 胡罢生, 等.踝关节X线片分析与临床应用.中华创伤骨科杂志, 2005, 7(4):332-334.
8.	Rose JD, Flanigan KO, Mlodzienski A. Tibiofiblar diastasis without ankle fracture:a review and report of two case. J Foot Ankle Surg, 2002, 41(1):44-51.
9.	Ovaska MT, Mädanat TJ, Madanat R, et al. Predictors of poor outcomes following deep infection after internal fixation of ankle fractures. Injury, 2013, 44(7):1002-1006.
10.	Beumer A, Valstar ER, Garling EH, et al. Kinematics of the distal tibiofibular syndesmosis:radiostereometry in 11 normal ankles. Acta Orthop Scand, 2003, 74(3):337-443.
11.	Lundberg A. Kinematics of the ankle and foot:in vivo roentgen stereophotogrammetry. Acta Orthop Scand, 1989, Supp233:1-26.
12.	Seyhan M, Donmez F, Mahirogullari M, et al. Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures. Injury, 2015, 46 Suppl 2: S19-23.
13.	Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am), 1976, 58(3):356-357.
14.	Taser F, Shfiq Q, Ebraheim NA. Three-dimensional volume rendering of tibiofibular joint space and quantitative analysis of change in volume due to tibiofibular syndesmosis diastases. Skeletal Radiol, 2006, 35(12):935-941.
15.	Klitzman R, Zhao H, Zhang LQ, et al. Suture-button versus screw fixation of the syndesmosis:a biomechanical analysis. Foot Ankle Int, 2010, 31(1):69-75.
16.	Schepers T. Acute distal tibiofibular syndesmosis injury:a systematic review of suture-button versus syndesmotic screw repair. Int Orthop, 2012, 36(6):1199-1206.
17.	Naqvi GA, Shafqat A, Awan N. Tightrope fixation of ankle syndesmosis injuries:clinical outcome, complications and technique modification. Injury, 2012, 43(6):838-842.
18.	Xu G, Chen W, Zhang Q, et al. Flexible fixation of syndesmotic diastasis using the assembled bolt-TightRope system. Scand J Trauma Resusc Emerg Med, 2013, 21:71.
19.	Storey P, Gadd RJ, Blundell C, et al. Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique. Foot Ankle Int, 2012, 33(9):717-721.
20.	Hsu YT, Wu CC, Lee WC, et al. Surgical treatment of syndesmotic diastasis:emphasis on effect of syndesmotic screw on ankle function. Int Orthop, 2011, 35(3):359-364.

1. Van Son MA, De Vries J, Roukema JA, et al. Health status, healthrelated quality of life, and quality of life following ankle fractures:a systematic re view. Injury, 2013, 44(11):1391-1402.
2. Egol KA, Pahk B, Walsh M, et al. Outcome after unstable ankle fracture:effect of syndesmotic stabilization. J Orthop Trauma, 2010, 24(1):7-11.
3. Stein G, Eichler C, Ettmann L, et al. Tibiofibular screw fixation for syndesmotic ruptures:a biomechanical analysis. Surg Radiol Anat, 2012, 34(7):593-597.
4. Wang C, Ma X, Wang X, et al. Internal fixation of distal tibiofibular syndesmotic injuries:a systematic review with meta-analysis. Int Orthop, 2013, 37(9):1755-1763.
5. Rigby RB, Cottom JM. Does the Arthrex TightRope^® provide maintenance of the distal tibiofibular syndesmosis? A 2-year followup of 64 TightRope^® in 37 patients. J Foot Ankle Surg, 2013, 52(5): 563-567.
6. Wang L, Wang B, Xu G, et al. Biomechanical comparison of bionic, screw and Endobutton fixation in the treatment of tibiofibular syndesmosis injuries. Int Orthop, 2016, 40(2):307-314.
7. 林昂如, 邹和荣, 胡罢生, 等.踝关节X线片分析与临床应用.中华创伤骨科杂志, 2005, 7(4):332-334.
8. Rose JD, Flanigan KO, Mlodzienski A. Tibiofiblar diastasis without ankle fracture:a review and report of two case. J Foot Ankle Surg, 2002, 41(1):44-51.
9. Ovaska MT, Mädanat TJ, Madanat R, et al. Predictors of poor outcomes following deep infection after internal fixation of ankle fractures. Injury, 2013, 44(7):1002-1006.
10. Beumer A, Valstar ER, Garling EH, et al. Kinematics of the distal tibiofibular syndesmosis:radiostereometry in 11 normal ankles. Acta Orthop Scand, 2003, 74(3):337-443.
11. Lundberg A. Kinematics of the ankle and foot:in vivo roentgen stereophotogrammetry. Acta Orthop Scand, 1989, Supp233:1-26.
12. Seyhan M, Donmez F, Mahirogullari M, et al. Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures. Injury, 2015, 46 Suppl 2: S19-23.
13. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am), 1976, 58(3):356-357.
14. Taser F, Shfiq Q, Ebraheim NA. Three-dimensional volume rendering of tibiofibular joint space and quantitative analysis of change in volume due to tibiofibular syndesmosis diastases. Skeletal Radiol, 2006, 35(12):935-941.
15. Klitzman R, Zhao H, Zhang LQ, et al. Suture-button versus screw fixation of the syndesmosis:a biomechanical analysis. Foot Ankle Int, 2010, 31(1):69-75.
16. Schepers T. Acute distal tibiofibular syndesmosis injury:a systematic review of suture-button versus syndesmotic screw repair. Int Orthop, 2012, 36(6):1199-1206.
17. Naqvi GA, Shafqat A, Awan N. Tightrope fixation of ankle syndesmosis injuries:clinical outcome, complications and technique modification. Injury, 2012, 43(6):838-842.
18. Xu G, Chen W, Zhang Q, et al. Flexible fixation of syndesmotic diastasis using the assembled bolt-TightRope system. Scand J Trauma Resusc Emerg Med, 2013, 21:71.
19. Storey P, Gadd RJ, Blundell C, et al. Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique. Foot Ankle Int, 2012, 33(9):717-721.
20. Hsu YT, Wu CC, Lee WC, et al. Surgical treatment of syndesmotic diastasis:emphasis on effect of syndesmotic screw on ankle function. Int Orthop, 2011, 35(3):359-364.

Chinese Journal of Reparative and Reconstructive Surgery

SHORT-TERM EFFECTIVENESS OF TightRope SYSTEM FOR TREATMENT OF SYNDESMOTIC TIBIOFIBULAR DIASTASIS

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