Syndesmotic injuries to the ankle occur in approximately 10 percent of all patients with ankle fractures, but they can also occur with soft-tissue injuries in the absence of fracture. They usually result from severe external rotation of the ankle, and treatment remains controversial.
Historically, treatment has involved tibiofibular transfixation using a syndesmotic screw. Surgery to reduce and fix the diastasis is recommended to prevent lateral talar shift. But recently, tightrope fixation—a new implant technology involving a fiberwire suture and two buttons—has been introduced.
Tightrope fixation was developed as an alternative to avoid common screw complications. One or two fixation devices can be used, depending on the degree of stability required. The device consists of a fiberwire suture and two buttons—one oblong to enable it to pass through the bone and the other round to serve as a restraint on the lateral side.