Outcome and complications of treatment of ankle diastasis with tightrope fixation

Fixation of ankle syndesmosis injury with a fibre-wire tightrope has previously been reported. Early clinical results indicate that it can remain in situ indefinitely without complications. We are the first to report complications with the use of this device. Six patients were treated for ankle diastasis using the tightrope. These included four Weber C fractures, one Maisonneuve fracture and one isolated diastasis without fracture. Fractures were treated according to AO-ASIF principles and the tightrope applied through a plate in three cases and directly through the fibula in three cases. In two cases the device caused soft-tissue irritation with granuloma formation, necessitating subsequent removal, one after six months, and the other after ten months. Histological examination revealed refractile material within giant cells, suggestive of foreign-body reaction. Average time to weightbearing was six weeks (range 4–8). In all cases the syndesmosis was reduced and held, even after device removal. Functional outcome was good and patients were satisfied. This series shows that there is a significant incidence of soft-tissue complications with the use of tightrope fixation and subsequent need for removal. Patients should be warned of this.