Tibialis Posterior Tendon Dysfunction Due to Syndesmotic Fixation Using Non-absorbable Suture Button Device Following Fracture-Dislocation of the Ankle: A Case Report

Fracture-dislocation of the ankle is a common lower limb injury, often associated with syndesmotic damage. While CT and MRI scans are more sensitive than plain radiographs in diagnosing syndesmotic injuries, treatment typically involves either static stabilization using metallic screws or dynamic stabilization with a suture button device. The primary advantage of dynamic stabilization is that it eliminates the need for a second surgery to remove screws. However, chronic syndesmotic injuries can lead to significant morbidity, including pain and impaired function. In patients with inflammatory conditions, such as rheumatoid arthritis, dynamic stabilization may result in loosening and migration of the suture button, potentially causing tendon degeneration and rupture. We present the case of a 63-year-old woman with rheumatoid arthritis who sustained a fracture-dislocation of the ankle. She was treated with open reduction and internal fixation, using a plate, screws, and a suture button device for syndesmotic stabilization. Postoperatively, she developed a plano-valgus deformity due to migration of the suture button into the tibialis posterior tendon and degenerative arthritis of the syndesmosis joint.