Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique.

BACKGROUND: The TightRope® is a relatively new device designed to stabilize ankle syndesmotic injuries. There are no studies evaluating the clinical effectiveness of this technique and few reports addressing complications and potential modifications to the surgical technique reported in this article. MATERIALS AND METHODS: A retrospective review of 102 cases of traumatic ankle syndesmotic stabilization using the TightRope device is presented. Patients were followed up for a median of 85 days after surgery. RESULTS: Eight patients subsequently had the TightRope removed. This was performed for four reasons: osteomyelitis surrounding the implant, painful aseptic osteolysis surrounding the implant, failed stabilization of the syndesmosis, and unexplained pain. CONCLUSIONS: On the basis of experience, the authors recommend meticulous attention during the surgical technique. To prevent skin irritation and stitch abscess formation leading to osteomyelitis, the FiberWire loop is best cut with a knife at least 1 cm beyond the knot, allowing the sharp end of the FiberWire to lay flat adjacent to the fibula. Painful aseptic osteolytic reaction to the TightRope necessitates removal. To prevent rediastasis, a small medial incision is recommended for endobutton positioning directly abutting the tibial cortex without soft tissue interposition. Inserting the TightRope through a fibula plate prevents lateral button pull-through and rediastasis.

Transverse Weber A fracture atrophic non-union. A single centre case series.

INTRODUCTION: Weber A ankle fractures are isolated fibula fractures distal to the level of the ankle joint line. They are regarded as stable injuries that usually heal successfully without intervention. We have identified several patients that have developed symptomatic atrophic non-union of transverse Weber A fractures that are not simple avulsion fractures of the anterior talo-fibular ligament. We explored variations to the blood supply of the distal fibula as a potential cause of this rare complication. CASES: Five patients presented with ongoing ankle pain following a period of non-operative management. All shared a similar transverse atrophic non-union fracture pattern.Surgical management with open reduction and internal fixation with or without the use of bone graft achieved successful union and resolution of symptoms in all cases. CONCLUSIONS: Atrophic fracture non-unions usually result from a disruption to the blood supply at the site of injury. The arterial supply to the distal fibula consists of a complex of arterial loops which usually enable fracture healing. However, there are anatomical variations to the blood supply that potentially could account for the rare outcome of non-union of Weber A fracture patterns. Weber A fractures are generally benign ankle fractures that heal well with non-operative treatment. No alterations should be made to the management of such injuries, but patients should be counselled about the risk of a symptomatic non-union outcome.

Assessment of a three-grade classification of complications in total ankle replacement.

BACKGROUND: Prompted by the success of hip and knee arthroplasty, total ankle replacement (TAR) has become increasingly popular as a treatment for end stage arthritis of the ankle. A 3-grade classification of complications to assist in prediction of early implant failure has been proposed. We have compared the experience of a tertiary referral center in the United Kingdom to the proposed system. METHODS: A retrospective review of the Sheffield Foot and Ankle Unit TAR database was performed from 1995 to 2010. All complications were recorded and categorized using Glazebrook et al's proposed system of increasing severity. Low-grade complications including postoperative bone fracture, intraoperative bone fracture, and wound healing problems rarely lead to revision. Medium-grade complications, technical error and subsidence, lead to failure <50% of the time. High-grade complications--deep infection, aseptic loosening, and implant failure--lead to revision >50% of the time. In our center, 217 TAR were implanted in 198 patients with a minimum follow-up of 30 months. RESULTS: The complication rate was 23%, with a revision rate of 17%. All complications recorded in our study except intraoperative bone fracture and wound healing had a failure rate of at least 50%. CONCLUSION: Unfortunately most complications associated with TAR have a significant impact on the life span of a TAR. Glazebrook et al's proposed 3-tier system did not reliably reflect our experience. Hence, we would categorize complications as either high or low risk for early failure of TAR. LEVEL OF EVIDENCE: Level IV, case series.