• Lei Zhang, Ji-Xiang Xiong, Xin Zhou, Lu-Jing Xiong, and Lin Yu.
• Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China, 646000; Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou,China, 646000; Expert Workstation in Luzhou, Luzhou, Sichuan, China, 646000; Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China, 646000. Electronic address: zhanglei870722@126.com.
• Injury. 2021 Oct 1; 52 (10): 2813-2819.

BackgroundAdequate reduction and stabilization of the syndesmosis are significant to prevent early degeneration of the ankle joint and get better clinical outcomes. However, the routine surgical methods have diffierent limitations. The purpose of this study was to develop a novel double Endobutton fixation to treat the distal tibiofibular syndesmotic injuries, and determine whether the novel double Endobutton fixation demonstrates a better biomechanical property compare with the intact syndesmosis, the screw fixation and the Tightrope fixation.MethodsTwenty-four normal fresh-frozen ankle specimens with a mean age of 42 ± 8 (range, 28-62) years were randomly divided equally into four groups: (1) the intact group, (2) the screw group, (3) the Tightrope group, (4) the Endobutton group. 3D printer technology was used to establish the personalized distal tibiofibular syndesmotic navigation modules to determine the accurate bone tunnel. Axial loading was applied in five ankle positions: neutral position, dorsiflexion, plantar flexion, varus and valgus. Rotation torque was applied in two ankle rotation of the neutral position: internal and external.ResultsIn most situations, the displacements of the intact group were larger than the screw group, the Tightrope group and the Endobutton group (P < .05), and the displacements of the screw group were smaller than other three groups (P < .05). The displacements of the double Endobutton group were slightly larger than the Tightrope group but no significant differences were found between these two groups except in the dorsiflexion position of axial loading experiments (P < .05). The novel double Endobutton fixation was steadier than intact syndesmosis and more micromotional than screw fixation.ConclusionOur study demonstrated that the novel double Endobutton can be considered as the better fixation in treatment of distal tibiofibular syndesmotic injuries.Level Of EvidenceLevel III, retrospective comparative study.Copyright © 2021. Published by Elsevier Ltd.

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