Tight rope fixation in fracture management

The use of tightrope fixation using metal buttons linked by suture material was first reported in 2005 when their use was suggested as an alternative to syndesmosis screws in ankle fractures associated with a diastasis. These implants are now used widely as a component of fixation in ankle fractures with a diastasis. The published results of their use in these injuries have shown that they are an effective method of treating diastasis of the ankle tibio-fibular syndesmosis with some evidence to suggest that they have a lower rate of malunion, fewer implant related complications, a reduced need for implant removal and in some trials better functional outcomes than screw fixation. Variations of these devices have also been used for fixation of lateral third clavicular fractures and acromioclavicular dislocations. Their use alone or in combination with plate fixation has been shown to be an effective method of fixation of lateral third clavicle fractures with a low rate of malunion and implant related problems. They have also shown to be an effective method of treatment for acromioclavicular dislocation, although there is still debate about the role of surgical treatment for these injuries. There are miscellaneous reports of their use for other fractures and dislocations in other anatomic locations notably for Lisfranc injuries in the foot. Better quality prospective clinical studies are still needed to define their exact role in fracture management.