Exploração operatória e redução de sindesmose em lesão de tornozelo de Weber tipo C

Abstract

OBJECTIVE: To investigate the surgical methods in treating Weber type C ankle injury and estimate the necessity of syndesmosis operative exploration. METHODS: Forty three patients of Weber type C ankle injury were treated with open reduction and internal fixation from October 2004 to December 2009. Twenty nine patients were treated with routine procedure by open reduction and internal fixation, syndesmosis exploration and repair were performed in addition in the others. Thirty four patients were followed during an average time of 31.2 months (range 18 to 50 months), amomg them 22 patients were treated with routine procedures and 12 were treated with additional syndesmosis surgical exploration. RESULTS: All the fractures were reunited in an average time of 13.1 weeks (range 10 to 18 weeks) and full weight bearing began. The mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 79.86(range 65 to 98) in the routine procedures group and 86.67 (range 78 to 100) in the syndesmosis exploration group and Olerud-Molander score was 77.27 (range 55 to 100) and 86.67 (range 75 to 100) respectively. Statistically significant difference was found between the two groups (P<0.05). CONCLUSION: Syndesmosis surgical exploration is an essential treatment in some Weber type C ankle injuries, which make debridement and direct reduction of the syndesmosis possible, providing thus a more stabilized ankle joint. Level of Evidence III, Retrospective Comparative Study

Evaluating success rate and comparing complications of operative techniques used to treat chronic syndesmosis injuries

“…31 This step is crucial to allow for proper implantation of hardware, and to obtain adequate range of motion postoperatively. Yang et al 32 demonstrated the benefits of arthroscopic exploration and debridement in a prospective study of 34 patients who had Weber type C ankle injuries and concomitant syndesmotic injuries. There were 22 patients who were treated with open reduction and internal fixation only and the remaining 12 patients were treated with open reduction and internal fixation plus direct syndesmosis exploration and debridement.…”

Syndesmosis assessment in postoperative patients subjected to surgical treatment of supra-syndesmotic fracture

“…Para Yang et al (6) , a redução anatômica e fixação estável da sindesmose proporcionam resultado clínico favorável. Visualização direta, desbridamento, redução aberta e reconstrução da sindesmose são indicados nas lesões de tornozelos Weber tipo C, para assegurar uma articulação estável.…”

“…Acredita-se que a fixação interna deva ser precedida de uma técnica de redução aberta, mediante visualização direta, na tentativa de restabelecer, da maneira mais fisiológica possível, o comprimento fibular e a reconstrução da pinça do tornozelo (3,6 ) .…”

“…A osteossíntese da fratura da fíbula, mediante técnica de redução aberta e fixação interna, constitui fator de-terminante para obtenção dos parâmetros adequados. Há que se ressaltar que fraturas expostas, com perda óssea, ou fraturas cominutivas podem dificultar a obtenção de uma redução caprichosamente adequada, o que levaria a uma alteração do ATC (6) . Neste estudo, dos 3 pacientes (8,3%) que tiveram medidas inferiores a 8mm, apenas 1 divergiu em mais de 2 a 3 graus com o lado contralateral, sendo o único a ter ficado fora da normalidade.…”

“…Além de tratar a fratura propriamente dita, é necessário também avaliar a integridade da sindesmose. Tem-se tornado evidente que uma redução anatômica deste tipo de fratura é fundamental para obtenção de bons resultados, sendo melhor obtida mediante redução aberta (6) .…”