Hi, I'm Mike Swords, and I'm going to present our project, Novel Dynamic Screw Suture Stabilization System for Sinus Monic Repair Provides Better Anteroposterior Translation and Axial Tibial Failure Joint Stability, a Human Cadaveric Study. I'd like to acknowledge my co-authors and the AO Research Institute in Davos. Screw Suture Sinusmosis Repair System provides both screw fixation and suture flexibility. It enables precise anatomic sinus monic fixation, and it reduces the rates of complications in revision surgeries associated with static screw fixation. It addresses limitations of suture button constructs, including lack of two-way tension control and medial soft tissue disruption. It can be applied in combination with a plate, or it can be used as a standalone device with a washer. The principles of operative management of ankle fractures with associated sinus monic injury include restoration of fibular length and rotation, as well as correct sinus monic reduction, alignment, and maintenance of alignment. The treatment of length-unstable fibular fractures poses challenges, particularly when there's no plate fixation, and the question exists whether length and rotation can be restored by sinus monic fixation alone. The aim of our study was to evaluate the performance of a screw suture device versus a suture button device for stabilization of length-unstable fibular fractures in a human cadaveric model. We had eight pairs of fresh frozen human lower legs with soft tissue. The fibula was left free to move. We had simulation of pronation inversion injuries, types three and four, with complete cutting of the sinus monic and delta ligaments. The groups were assigned pairwise for instrumentation between a screw suture and a suture button device, inserted 20 millimeters distance approximate from the tibia plafond, as illustrated in the images to the right. CT scanning was performed in five foot positions, neutral, dorsiflexion, plantarflexion, external rotation, and internal rotation. We did a 700 newton single leg axial loading, and there were four sequences performed, intact, injured, reconstructed, and post-biomechanical testing. The biomechanical testing setup included a tibia vertically mounted, the foot was placed plain in neutral position, the hind foot was constrained by stoppers, and the forefoot was constrained with metal clamps. The loading protocol included cyclic loading over 5,000 cycles with 1,400 newtons of axial and plus or minus 15 degrees of torsional loading. Transmission tracking was performed, recording relative movements between tibia, fibula, and talus in six degrees of freedom. When looked at the clear space on CT loaded, this was normalized to the intact state with all foot positions together. When we compared injured versus intact, there was obviously a significant destabilization in each group. When we evaluated repaired versus intact, there was significant over-compression in each group. When we compared the tested versus intact, there was no significant difference in each group. When compared between the groups in the repaired state, there was a significant difference in clear space normalization in all foot positions. When we looked at AP and axial movement, we noted a significant difference between groups When comparing the fibulink to the tightrope, you can see the fibulink was much more reliable in our testing model in controlling AP movement. And when we looked at axial movement of the fibula and the device, again, the fibulink outperformed the tightrope in axial movement. In conclusion, both implant systems demonstrate the ability for stabilization of unstable syndesmotic injuries and that the screw suture reconstruction using the fibulink provided better AP and axial tibiofibular joint stability and maintained that stability over time under dynamic loading and that the screw suture reconstruction is a valid option for treatment of syndesmotic disruptions. Thank you.

Mike Swords

Novel Dynamic Screw Suture Stabilization System

Sinus Monic Repair

screw fixation

suture flexibility