Suture fixation of acute disruption of the distal tibiofibular syndesmosis

The procedure

Suture fixation of acute disruption of the distal tibiofibular syndesmosis is a way of fixing a sprained ankle. The aims of this procedure include a more rapid return to weight bearing, more normal ankle movement, and a reduced need for further surgery.

It is done either with a general or spinal anaesthetic. Antibiotics are given to prevent infection. A cut is made on the outside of the ankle to get into the joint. If the ankle is broken as well as sprained, the fracture is fixed first in the standard way. Then, the damaged ligaments are moved into the correct position and the ankle is held in place with a clamp. A small tunnel is drilled through the bones (tibia and fibula). A suture (a special thread) with an oblong metal button on it is then threaded through the tunnel using a needle. The button lies flat on the outside of the tibia, and the ends of the suture are pulled tight against the outside of the fibula and held in place with a second metal button. The free ends of the suture are then tied in a knot to fix the joint. If extra stability is needed, a second suture can be put through the same or another tunnel. The suture is usually left in place.

The cut is closed and the ankle is put in a below‑the‑knee cast. No weight should be put on the ankle for the first 2 weeks after the operation. From weeks 2 to 6, there can be partial weight bearing and, after 6 weeks, full weight bearing. Once the ankle has healed, the patient is given physiotherapy.