Management of Syndesmotic Injuries in Children and Adolescents: Results of a Cross-Sectional Survey of Pediatric Orthopaedic Surgeons

Introduction: Although syndesmotic injury management in adults has shown improved outcomes with suture-button versus screw fixation, this has not been demonstrated in pediatric populations. This study investigates trends in syndesmotic injury management by conducting a survey of pediatric orthopaedic surgeons. Methods: The Children's Orthopaedic Trauma and Infection Consortium for Evidence-Based Studies group was surveyed for information regarding their surgical fixation preference for syndesmotic ankle injuries. Results: A survey response of 100% (30/30 members) was obtained. Most of the respondents practiced in a metropolitan setting (86.7%) and reported working in a pediatric specialty hospital (73.3%). 86.7% (n = 26) treated 0 to 5, 10% (n = 3) treated 6 to 10, and 3.33% (n = 1) treated over 10 pediatric syndesmotic ankle injuries in the past year. 70% (n = 21) of respondents preferred suture-button fixation while 30% (n = 9) preferred screw fixation. Furthermore, 50% (n = 15) of respondents reported a change in their implant preference since the start of their practice, with “avoidance of secondary surgery” and “extrapolation from outcomes in adults” as the most cited reasons at 86.7% and 73.3%, respectively. Discussion: Our findings indicate that the shift from screw to suture-button fixation is due to an interest in avoiding secondary surgery for implant removal and by extrapolating results from adult studies.