Benefits and risks

Information for the public

When NICE looked at the evidence, it decided that Suture fixation of acute disruption of the distal tibiofibular syndesmosis is safe enough and works well enough for use in the NHS. The 9 studies that NICE looked at involved a total of 323 patients.

Generally, there was improved function at 12 months compared with screw fixation. But, there was no difference in range of ankle movement, pain, weight bearing, recurrent sprains or dislocations, or time taken to return to work or previous sporting activities.

The studies showed that the risks of suture fixation included:

suture removal in up to 25% of patients after 2 years because of:
- local skin irritation from the suture knot a few months after surgery in 10 patients
- persistent pain with activity and restricted ankle movement in 1 patient
- deep wound infection in 2 patients
- infection of bone around the suture in 3 patients
- painful widening of the suture tunnel in 2 patients
- continued ankle instability in 2 patients
- unexplained pain in 1 patient
- an abscess in 1 patient
- local nerve damage in 1 patient
- joint damage in 1 patient.
wearing of the suture buttons into the bone in 17% of patients
non‑fatal blood clot in a leg or to a lung in 2% of patients
trapped tendon and nerve in 1 patient, who needed another operation but recovered
bone formation on ligaments around the ankle in 17% of patients
joining of the tibia and the fibula bones together at the ankle (caused by extra bony growth) in 1 patient (no further details)
acute fracture of the tibia and fibula bones in 1 patient, who needed further surgery but fully recovered.

NICE was also told about some other possible risks: difficulty with tightening the suture sufficiently, and failed fixation.

If you want to know more about the studies, see the guidance. Ask your health professional to explain anything you don't understand.