Methods of Tibiofibular Syndesmosis Fixation

The tibiofibular syndesmosis is a ligamentous structure connecting the distal ends of the tibia and fibula. This article presents and compares the available methods of treatment of syndesmosis injuries. Current publications from the online database PubMed and relevant available books are analysed and compared with AO Surgery guidelines. Metal and bioabsorbable syndesmotic screws and the suture button technique, including all possible modifications of these approaches, are compared. The focus is on the technical aspects of the procedures, functional outcomes and complications of these procedures. According to the literature, the best long-term functional outcomes are obtained with the dynamic fixation method involving the suture button. This fixation technique is closest to a physiological connection, there is no need to subsequently remove the implant and return to work is faster. Given all this, the popularity of this fixation technique can be expected to increase dynamically.