BACKGROUND Tightrope fixation is an emerging technique for syndesmotic fixation with promising results. However, our case series highlights the slippage of Tightrope buttons as a complication of suture button syndesmotic fixation of Weber C malleolar fractures using limited contact dynamic compression (LCDCP) plates. METHODS We report a series of cases from our database in which slippage of the Tightrope button through the LCDCP holes in Weber C malleolar fractures was noted. We measured the medial clear space (MCS), tibiofibular clear space (TFCS), and distal tibiofibular overlap (DTFO) and computed the largest change in these measurements from the first postoperative follow-up radiographs. Patient records were reviewed for persistent symptoms that could be attributed to the loss of syndesmotic fixation and stability. RESULTS Follow-up radiographs of 3 patients showed a slippage of the Tightrope button through the LCDCP holes. Two of the patients reported persistent ankle pain and swelling with prolonged activity. The mean increases in MCS and TFCS among these patients were 0.7 (±0.081) mm and 1.5 (±0.798) mm, respectively. The mean decrease in DTFO was 2.2 (±0.864) mm. We next highlight 3 patients with Weber C malleolar fractures who underwent suture button syndesmotic fixation using double-stacked one-third tubular plates instead of the LCDCP. CONCLUSION This case series reported Tightrope button slippage as an early complication of syndesmotic fixation of Weber C malleolar fractures. We propose the use of double-stacked one-third tubular plates instead of the LCDCP to avoid this complication. LEVEL OF EVIDENCE Level V, expert opinion.

中文翻译：

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韦伯C踝骨骨折联合固定术中钢索扣滑移：一个案例系列。

背景技术绳索固定是一种用于有希望的结果的下颌联合固定的新兴技术。但是，我们的病例系列突出了使用有限接触动态压缩（LCDCP）板对Weber C踝骨骨折的缝合纽扣联合固定的并发症，将钢丝绳纽扣打滑。方法我们从数据库中报告了一系列案例，这些案例中，注意到在Weber C踝骨骨折中，钢索扣滑过LCDCP孔。我们测量了内侧间隙（MCS），胫腓间隙（TFCS）和胫腓远端重叠（DTFO），并根据术后第一张X线片计算出这些测量值的最大变化。回顾了患者记录中的持续症状，这些症状可能归因于下突固定和稳定性的丧失。结果3例患者的随访X射线照片显示，绳索按钮从LCDCP孔中滑出。其中两名患者报告持续脚踝疼痛和肿胀，并伴有长时间活动。这些患者中MCS和TFCS的平均增加分别为0.7（±0.081）mm和1.5（±0.798）mm。DTFO的平均下降为2.2（±0.864）mm。接下来，我们重点介绍3例Weber C踝部骨折患者，他们使用双层堆叠的三分之一管状钢板代替LCDCP进行了缝合纽扣联合固定术。结论该病例系列报道了钢丝扣滑移是Weber C踝骨骨折的下颌骨联合固定的早期并发症。为了避免这种复杂性，我们建议使用双层的三分之一管状板代替LCDCP。证据级别V，专家意见。