Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 6 2026 11 01 Pain and Surgical Outcomes in Ankle Fracture and Syndesmosis Injury: Comparing Screw and Flexible Fixation Methods in a Cohort Study 1649 1656 234046 10.30491/tm.2025.489826.1786 EN Arash Aris Department of Orthopedics, Orthopedic Research Center, Trauma Institute, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran 0000-0002-0446-3489 Kamran Asadi Department of Orthopedics, Orthopedic Research Center, Trauma Institute, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran 0000-0003-3885-1057 Amir Farhangi Department of Orthopedics, Orthopedic Research Center, Trauma Institute, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran 0009-0009-0103-6543 Mohammadali Yazdanipour Neuroscience Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran 0000-0001-9084-0887 Nima Faghirpour Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran 0009-0004-9270-9478 Journal Article 2024 11 26 Introduction: Although the importance of anatomical repair and fixation for syndesmotic injury has been emphasized, the best surgical approach remains a topic of discussion. This study sought to evaluate and compare the post-operative pain and surgical outcomes between screw fixation and the suture endobutton method in patients with Weber type C ankle fractures. Methods: A total of 56 consecutive patients with Weber type C ankle fractures participated in this prospective cohort study and underwent either screw fixation or suture endobutton surgery in 2022. Pain, infection, and the Foot and Ankle Outcome Score (FAOS) were monitored 3, 6, and 12 months’ post-operation. Results: The study included 14 women and 42 men, aged 18 to 47 years. There were no differences in age and sex between the two surgical groups. The pain score was significantly lower in the suture endobutton group compared to the screw fixation group three months after the operation (P=0.042). However, the two groups had no significant differences in pain scores at six and twelve months. Within each treatment method, the pain scores were statistically significantly different over time (Ptotal<0.001 in two groups). The suture endobutton method resulted in higher FAOS scores compared to the screw fixation method at three, six, and twelve months after surgery. The difference in this score within each group during the follow-up period was statistically significant (Ptotal<0.001 in two groups). Conclusion: The suture endobutton method has demonstrated advantages over screw fixation surgery. Patients have improved performance at three, six, and twelve months’ post-surgery, indicating that it may be a potentially superior approach to treating syndesmosis injuries.

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