Fantry Amanda J, O'Donnell Seth W, Born Chris T, Hayda Roman A
Orthopedics. 2017 May 1;40(3):e541-e545. doi: 10.3928/01477447-20161229-02. Epub 2017 Jan 6.
Suture button devices such as the TightRope (Arthrex, Naples, Florida) have been increasingly used for syndesmotic fixation of ankle fractures. Despite proposed advantages, prior studies have shown equivalent outcomes, with a theoretical decreased need for removal of hardware. Complications of suture button fixation of syndesmotic instability may be underreported and include lateral suture knot inflammation with or without granuloma formation, infection, aseptic osteolysis with widening of the tibial drill tunnels, heterotopic ossification, and osteomyelitis. In this case series, the authors review the current literature and describe 3 patients with TightRope fixation for syndesmotic instability who developed deep infection. The authors believe that braided suture within suture button devices may provide an environment conducive to the propagation of infection across the syndesmotic fixation tract. Evidence of suture button migration or osteolysis of the TightRope tract should prompt an infectious workup and removal of hardware. If there is concern for infection associated with the TightRope, the authors recommend removing both metallic buttons and the entirety of the suture to prevent harboring a nidus for further infection. [Orthopedics. 2017; 40(3):e541-e545.].
诸如TightRope（美国佛罗里达州那不勒斯市的Arthrex公司生产）之类的缝线纽扣装置已越来越多地用于踝关节骨折的下胫腓联合固定。尽管有其宣称的优势，但先前的研究表明其疗效相当，理论上减少了取出内固定装置的需求。下胫腓联合不稳定的缝线纽扣固定的并发症可能未得到充分报道，包括外侧缝线结炎症伴或不伴肉芽肿形成、感染、无菌性骨溶解伴胫骨钻孔隧道增宽、异位骨化和骨髓炎。在本病例系列中，作者回顾了当前文献，并描述了3例因下胫腓联合不稳定采用TightRope固定而发生深部感染的患者。作者认为，缝线纽扣装置内的编织缝线可能提供了一个有利于感染沿下胫腓联合固定通道扩散的环境。缝线纽扣移位或TightRope通道骨溶解的证据应促使进行感染方面的检查并取出内固定装置。如果担心与TightRope相关的感染，作者建议移除金属纽扣和整个缝线，以防止形成进一步感染的病灶。[《骨科》杂志。2017年；40(3):e541 - e545。]
