Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: A prospective and comparative study

Zhan, Yu; Yan, Xiaoyu; Xia, Ronggang; Cheng, Tao; Luo, Congfeng

doi:10.1016/j.injury.2016.04.014

Cited by 36 publications

(40 citation statements)

References 30 publications

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“…Of the 25 patients, 14 (56%) were male and 11 (44%) were female. The fractures were classified according to the Lauge-Hansen fracture type (18). No statistically significant differences were found in age, gender, fracture classification, side of injury, presence of diabetes, or smoking rate between the 2 groups (p > .05).…”

Section: Resultsmentioning

confidence: 97%

Novel Elastic Syndesmosis Hook Plate Fixation Versus Routine Screw Fixation for Syndesmosis Injury

Xian

Miao

Zhou

et al. 2018

The Journal of Foot and Ankle Surgery

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Unstable external-rotation type ankle fractures with concomitant syndesmosis injury commonly occur. Syndesmosis screw fixation has long been regarded as a reference standard treatment for syndesmosis injury. However, its complications and biomechanical disadvantages have become controversial; thus, we designed a novel elastic syndesmosis hook plate (ESHP) that combines the features of both rigidity and flexibility. The purpose of the present study was to introduce this new method and compare its clinical outcomes with those of routine screw fixation. We randomized 25 patients to the screw fixation group and ESHP group. The average follow-up period was 12 months. The clinical outcomes included malreduction or loss of reduction, overall complications, and function. During the follow-up period, 3 cases (25%) of malreduction were found in screw fixation group on postoperative computed tomography. In the ESHP group, only 1 patient (7.69%) had a narrowed anterior gap between the distal tibia and fibula. However, the difference in the malreduction rate between the 2 groups was not significant statistically (p = .32). The overall complication rate in the ESHP group was lower than that in the screw group, although no significant differences were found between the 2 groups. The mean visual analog scale scores in the ESHP and screw groups were 1.46 ± 1.33 and 2.42 ± 2.07, respectively. The average dorsiflexion range of motion in both groups was satisfactory (14.77° versus 12.83°; p = .16). However, a statistically significant difference was found in the plantarflexion range of motion between the 2 groups (p < .05). In addition, the ESHP group had an earlier time to return to work (p < .05). The ESHP fixation construct can stably fix syndesmosis, retain the physiologic micromotion function of the syndesmosis, and results in fewer complications compared with routine syndesmosis screw fixation for syndesmotic instability. In conclusion, our results have shown ESHP to be a viable method for treatment of syndesmosis instability.

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Section: Resultsmentioning

confidence: 97%

Novel Elastic Syndesmosis Hook Plate Fixation Versus Routine Screw Fixation for Syndesmosis Injury

Xian

Miao

Zhou

et al. 2018

The Journal of Foot and Ankle Surgery

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“…It is widely believed that accurate reduction and adequate fixation of syndesmosis injuries will result in superior radiographic and functional outcomes (1)(2)(3)(4). To accomplish better outcomes, various methods of reduction and fixation have been described (11,(14)(15)(16). Although clamp reduction has been widely used (9,13,14,16), reduction with manual manipulation has been considered to achieve compatible clinical outcomes and complication rates (19).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the most common operative method used to reduce the syndesmosis has involved placement of a pointed reduction clamp around the distal tibia and fibula to maintain reduction of the syndesmosis with fixation (9-13). Although many newly introduced fixative devices have shown good results, the traditional transsyndesmotic screw fixation method is still popular for fixation of the syndesmosis (11,(14)(15)(16).…”

mentioning

confidence: 99%

Comparison of Clamp Reduction and Manual Reduction of Syndesmosis in Rotational Ankle Fractures: A Prospective Randomized Trial

Park

Ahn

Choi

et al. 2018

The Journal of Foot and Ankle Surgery

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An optimal outcome of surgical treatment for a syndesmotic injury depends on accurate reduction and adequate fixation. It has been suggested that the use of a reduction clamp for reduction of the syndesmosis results in better reduction and a lower rate of redisplacement than manual reduction. However, these concepts have never been scientifically evaluated. We compared these 2 methods in a prospective randomized trial. A total of 85 acute ankle rotational fractures combined with syndesmotic injury were randomized to syndesmosis reduction with either a reduction clamp or manual manipulation. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space immediately postoperatively and at the final follow-up examination. Ankle joint range of motion, visual analog scale score, Olerud-Molander ankle scoring system, and complications were obtained at the last follow-up visit to assess the clinical outcomes. Of the 3 radiographic measurements, the tibiofibular clear space and tibiofibular overlap differed significantly between the 2 groups (p < .05). The clinical outcomes did not differ significantly between the 2 groups (p > .05). Although differences were found in the radiographic measurements, most syndesmoses in both groups were within the normal range at the final follow-up visit, and the 2 methods of syndesmosis reduction provided similar clinical outcomes. Accordingly, the results of the present study suggest that both of these methods are effective and reliable for reduction of the syndesmosis in rotational ankle fractures.

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“…Sin diferencias entre 1 o 2 implantes dinámicos. Tampoco influye la disposición de los mismos ción ligamentosa directa con el supuesto beneficio de evitar la descarga prolongada (ante el riesgo de rotura del material), la comorbilidad por segundas intervenciones y las tasas de mala reducción sindesmal obtenidas con las técnicas indirectas (49,50) . En los últimos años se han realizado estudios comparando distintas técnicas de reparación ligamentosa con la fijación con un tornillo transindesmal en pacientes con fracturas de tobillo.…”

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“…Zhan et al muestran en su estudio prospectivo aleatorizado que la reparación con aumentación del LTFAI presenta resultados funcionales similares, pero con una rehabilitación más rápida y menor índice de complicaciones. Refieren que su técnica aporta estabilidad sindesmal dinámica inmediatamente tras la cirugía (50) .…”

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Medicina basada en la evidencia. Conclusiones

Fernández-Cebrián¹,

Villardefrancos-Gil²,

Dopazo-González³

2019

MACT

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Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: A prospective and comparative study

Cited by 36 publications

References 30 publications

Novel Elastic Syndesmosis Hook Plate Fixation Versus Routine Screw Fixation for Syndesmosis Injury

Novel Elastic Syndesmosis Hook Plate Fixation Versus Routine Screw Fixation for Syndesmosis Injury

Comparison of Clamp Reduction and Manual Reduction of Syndesmosis in Rotational Ankle Fractures: A Prospective Randomized Trial

Medicina basada en la evidencia. Conclusiones

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