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Biomechanical Comparison of Suture-External Button Fixation vs Internal Suspension Fixation for Tendon Transfers of

Rubini Pathy1, Daniel R Sturnick2, John S Blanco2

  • 11 Shriners Hospitals for Children-Springfield, Springfield, MA, USA.

Foot & Ankle International
|March 29, 2019
PubMed

Insights

Internal suspension fixation offers superior biomechanical stability for tendon transfers compared to external buttons. This method reduces displacement and avoids skin complications, making it a promising alternative for pediatric foot surgery.

Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Pediatric foot surgery

Background:

  • Traditional pediatric foot tendon transfers use external buttons, risking suture breakage and skin ulceration.
  • Internal suspension systems in adults show strong fixation and minimal displacement without skin issues.
  • This study compares biomechanical properties of both fixation methods in cadavers.

Purpose of the Study:

  • To compare the biomechanical properties of internal suspension versus external button fixation for tendon transfers.
  • To evaluate construct displacement under dynamic and static loading conditions.

Main Methods:

  • Nine adult cadaver feet were used, testing both fixation techniques in random order.
  • Video capture recorded construct displacement within the bone tunnel during dynamic and static loading.
  • Paired t-tests analyzed static and cyclic displacements between groups (alpha=0.05).

Main Results:

  • Internal suspension fixation showed significantly less displacement than the external button technique.
  • Dynamic loading: 0.3 mm (internal suspension) vs. 0.7 mm (external button), P=0.0115.
  • Static loading: 0.4 mm (internal suspension) vs. 2.2 mm (external button), P=0.0019.

Conclusions:

  • Internal suspension systems provide superior fixation strength for tendon transfers compared to external buttons.
  • This method eliminates risks of skin ulceration and the need for hardware removal.
  • Internal suspension is a viable alternative for tendon transfer fixation in pediatric foot surgery.
Abstract

Keywords:
EndoButtonbuttonsuture anchortendon transfer fixation

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