with a screw suture fixation device, results of 10 cases. The screw suture synosmosis device features both screw fixation and suture flexibility. It avoids complications and re-operation with static screws, like hard removal and breakage. There's no medial soft tissue disruption, risking injury to the saphenous nerve. They can be used as a standalone device with a washer or through a plate. Masenube fractures involve a fracture of the fibula in the proximal third with associated synosmosis injury. These fractures require restoration of length, alignment and rotation of the fibula and direct reduction and stabilization of the synosmosis. These are often length unstable patterns. The purpose of our series of our report is to report on a series of 10 patients with masenube type fractures treated with a new screw suture synosmodic device called the Fibulink. We had 10 cases. Restoration of fibula length was achieved indirectly by a variety of different means. There were no direct open reductions of the fibula fracture. The synosmosis was open reduced and visually confirmed to be reduced just above the level of the ankle in all cases and stabilization occurred with a screw suture device. We measured the talocrural angle and medial clear space. This was done on injury films, immediately postoperatively and a minimum of six months of follow-up. Our cohort included five males and five females. The average time to surgery was 12.3 days. The mechanism of injury included five patients that slipped on ice, four that fell on uneven walking surfaces and one patient that had a motorcycle accident. Associate injuries included two associate posterior malleolus fractures, one which was significant and required direct plate reduction and fixation. One medial malleolus fracture was treated with two screws and there were nine devices were inserted independently and one device was inserted through a four hole one third tubular plate. We measured the talocrural angle at an average follow-up of 14 months. We measured the talocrural angle at injury, which was an average of 8.92 degrees demonstrating the shortening of the fibula. Postoperatively, it was 13.8 degrees and on final, it was 13.5 degrees. We measured our medial clear space and our injury films at average 5.68 millimeters. Our postoperative measurements averaged 2.06 millimeters for the medial clear space and final measurements on average were 2.1 millimeters. During the course of our series, no device failures or removals occurred or were necessary during the study period. Here's an example case. The red arrow shows that the fibula is clearly shortened and mal-rotated. The central x-ray has demonstrated widened clear space in the fracture, which is somewhat short of the proximal fibula and then the full leg length film on the right demonstrates the entirety of the injury. The film on the left shows an intraoperative stress view. The two K-wires were inserted, a lamina spreader was inserted between the K-wires to achieve length and then a K-wire and reduction clamp were used to maintain length and alignment once it was achieved and reduction of the syndesmosis. All provisional fixation was maintained until the implant was inserted, as you can see in the film, which is second from the left and then it was removed. You see your final mortise and lateral image on the two films on the right. This is the same patient showing a sequence of mortise films ranging from intraoperative stress. Next one is injury to an intraoperative image second to the right showing the fibula link in place and the final image to the right showing a final X-ray 14 months post-injury. In conclusion, the screw suture device provided length stable fixation for treatment of masonry fracture patterns after reduction and that this reduction was maintained over time. Thank you.

screw suture synosmosis device

Fibulink

masonry fracture patterns

fibula fractures

length restoration