Dynamic syndesmotic stabilization with non-metallic bio-integrative fixation: A novel technique guide

<h2>Abstract</h2> Syndesmotic instability occurs in up to 20% of ankle fractures and may lead to asymmetric tibiotalar loading and early arthrosis if inadequately reduced. Traditional metallic fixation techniques, though effective, are associated with hardware removal rates exceeding 40% and malreduction rates approaching 35%. Bio-integrative fixation composed of continuous mineral fibers within a PLDLA matrix provides strength retention during healing while eliminating permanent hardware. We describe a reproducible technique utilizing OSSIOfiber® bio-integrative suture anchors for dynamic syndesmotic fixation. Under fluoroscopic guidance, a 2.5-mm tibial anchor is deployed through a 4.75-mm fibular tunnel, tensioned, and secured with a second anchor to achieve physiologic syndesmotic stabilization. Technical pearls, reduction verification, and postoperative assessment are outlined. This technique provides a minimally invasive, dynamic alternative for syndesmotic stabilization with the potential to reduce implant removal and malreduction risk. Early results and comparative evidence suggest equivalent fixation strength and radiographic outcomes to metallic devices, supporting bio-integrative fixation as a viable option for surgeons seeking a non-metallic solution.