Syndesmotic Fixation With Suture Button: Neurovascular Structures at Risk: A Cadaver Study

Area of Science:

• Orthopedic Surgery
• Anatomy
• Surgical Risk Assessment

Background:

• Syndesmotic injuries often require surgical fixation, with suture button placement being a common technique.
• Understanding the proximity of neurovascular structures to the fixation site is crucial for preventing intraoperative complications.

Purpose of the Study:

• To anatomically evaluate the saphenous nerve and greater saphenous vein variations.
• To assess the risk of direct injury to these structures during syndesmotic suture button fixation.

Main Methods:

• Ten below-knee cadaver specimens were used for the study.
• Suture buttons were placed at 1, 2, and 3 cm above the tibial plafond under fluoroscopic guidance.
• Distances from buttons to the saphenous nerve and greater saphenous vein were measured and analyzed.

Main Results:

• Saphenous nerve compression occurred in 10-20% of cases at 1-3 cm above the tibial plafond.
• Greater saphenous vein compression occurred in 10-20% of cases at 1-3 cm above the tibial plafond.
• Anatomic variations included single nerve branches in 7 specimens and two branches in 3 specimens.

Conclusions:

• Syndesmotic suture button fixation carries a 10-20% risk of injury to the saphenous nerve and greater saphenous vein.
• Neurovascular injury can occur despite fluoroscopic guidance and proper surgical technique.
• Direct medial visualization is recommended to minimize injury risk to these high-risk structures.