Assessment of Anatomic Risk During Syndesmotic Stabilization With the Suture Button Technique

Area of Science:

• Orthopedic Surgery
• Anatomy

Background:

• Tibiofibular syndesmosis injuries often require surgical fixation.
• The suture button technique is a common method for stabilizing these injuries.

Purpose of the Study:

• To evaluate the anatomical risk to superficial medial neurovascular structures during suture button insertion.
• To measure the proximity of the suture button to the greater saphenous vein.

Main Methods:

• A standardized suture button insertion technique was performed on 20 fresh frozen cadaveric limbs.
• The position of the suture button relative to the greater saphenous vein was documented.
• Entrapment of medial neurovascular structures was assessed.

Main Results:

• 14% of suture buttons were placed posterior to the greater saphenous vein.
• 2% were placed anterior to the greater saphenous vein.
• 4% were placed directly on the greater saphenous vein.
• 55% of insertions resulted in some entrapment of medial neurovascular structures.
• The mean distance from the suture button to the greater saphenous vein was 4.88 ± 4.44 mm.

Conclusions:

• Suture button placement for tibiofibular syndesmosis fixation poses a risk to superficial medial neurovascular structures.
• Utilizing a medial incision during the procedure is advised to prevent neurovascular entrapment.