Effective and sustainable syndesmotic injury repair using endobuttons and fibre-wire, in bimalleolar fractures

Ankle fractures are the most frequent fractures accounting for 10% of all fractures, having an incidence of about 184/100,000 per year. Moreover, after external rotation or dorsiflexion injuries, syndesmotic disruption typically occurs at the ankle. The physiologic normality of the joint gets affected after a transverse syndesmotic screw fixation, which decreases the magnitude of motion at the lower extremes of the tibia and fibula, reducing contact forces between bones, and increasing stress on the crural interosseous membrane (which may lead to screw breakage). With this concern, we thus suggested to achieving a semi-rigid dynamic stabilization of the syndesmosis, using an endobutton and transosseous suture. We present a case of a 22-year-old active male who had a Lauge-Hansen pronation-abduction type injury. He was managed with an eight holes anatomical plate for lateral malleolus, two 65 mm CC screws with a washer for medial malleolus, and two endobuttons (one on the tibial and other on the fibular side) with transosseous sutures to provide stabilization of the syndesmosis. With this concern, we thus suggested achieving a semi-rigid dynamic stabilization of the syndesmosis, using an endobutton and transosseous suture; which can help in early mobilization, is cost effective, and prevent a second surgery for the removal of the syndesmotic screw.