SLR - October 2015 - Alan Stuto

Comparison of Screw Fixation with Elastic Fixation Methods in Treatment of Syndesmosis Injuries in Ankle Fractures

Reference: Seyhan M, Donmez F, Mahirogullari M, Cakmak S, Mutlu S, Guler O. Comparison of Screw Fixation with Elastic Fixation Methods in the Treatment of Syndesmosis Injuries in Ankle Fractures. Injury. 2015 Jul; 46 Suppl 2: S19-S23.

Scientific Literature Review

Reviewed By:
Alan Stuto, DPM
Residency Program: University Hospital, Newark, NJ

Podiatric Relevance:
Ankle fractures are common injuries that are treated by foot and ankle surgeons. Syndesmotic injury can co-exist with these injuries as well, and are typically seen in Weber C fractures. Screw fixation is the conventional treatment in syndesmosis repair, and recently elastic fixation materials have been used which can be an alternative method.

Methods: Records of 110 patients with ankle fractures who had undergone surgical treatment by the same surgeon, from January 2007 to June 2011, were retrospectively analyzed. Thirty-seven of these patient had syndesmosis injury. A total of thirty-two patients were included in the study; seventeen patients who had undergone treatment with four cortex 4.5mm single cortical screw fixation and fifteen patients who had been treated with single level elastic fixation material Tightrope. Mean age was 32.5 years, and mean follow-up period was 14.6 months. All patients were non-weight bearing for six weeks, and progressed to partial weight bearing with crutches after this time. At twelve weeks, full weight bearing was initiated, and syndesmotic screw was removed if necessary. Patients were able to start running at 4 months and were allowed back to sporting activities at 6 months. X-rays at one, two, three, six, 12 months post op were evaluated.

Results: No statistically significant difference was observed between the pain scores, ankle functional scores, AOFAS scores, and difference of plantarflexion angles of the operated side from healthy side at the third month. There was a statically significant difference of the dorsiflexion angle seen in the operated side from healthy side. The range of dorsiflexion and plantarflexion motion of the elastic group at the sixth and twelfth months were significantly better compared to the screw group. All scores were assessed at three, six and twelve months post-op. Four patients complained of discomfort caused by syndesmotic screw. Two patients complained of discomfort caused by knot under skin in elastic fixation, and total of six patients had elastic fixation removed.

Conclusions: Untreated syndesmosis injuries in ankle fractures may lead to mechanical instability, which can result in early arthrosis. In the study of Ramsey and Hamilton, it was reported that 1mm dislocation of the talus to the lateral side had decreased tibiotalar contact surface are by 42 percent. Therefore, it is important to recognize and treat these injuries. The article provides evidence that elastic fixation method is as functional as the screw fixation method in treatment of syndesmosis injuries. No obligation to remove the elastic fixation material is one of the major benefits of this modality, along with decreasing the necessity for a second operation.

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