Deep Infections After Syndesmotic Fixation With a Suture Button Device

Area of Science:

• Orthopedic Surgery
• Medical Devices
• Infectious Diseases

Background:

• Suture button devices, like the TightRope, are increasingly used for syndesmotic fixation in ankle fractures.
• While proposed to offer advantages, studies show equivalent outcomes to traditional methods.
• Potential complications, including infection, may be underreported.

Observation:

• This case series describes 3 patients who developed deep infections after TightRope fixation for syndesmotic instability.
• The braided suture material within the device may create an environment conducive to infection propagation.
• Symptoms like suture button migration or osteolysis warrant an infectious workup.

Findings:

• Deep infection is a potential complication of suture button fixation for syndesmotic instability.
• The braided suture may act as a nidus for infection.
• Prompt removal of all hardware is recommended if infection is suspected.

Implications:

• Clinicians should be vigilant for signs of infection following syndesmotic fixation with suture buttons.
• An infectious workup is crucial if hardware migration or osteolysis is observed.
• Complete hardware removal is advised to manage and prevent persistent infection.