Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury

Abstract

Background:With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not be necessary for supra-syndesmotic fibular fractures combined with diastasis of inferior tibio-fibular joint. A retrospective observational study was performed in patients who had this injury pattern treated with syndesmosis-only fixation.Materials and Methods:12 patients who had Weber type-C injury pattern were treated with syndesmosis only fixation. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient had a single tricortical screw fixation across the syndesmosis. Patients were kept non-weight-bearing for 6 weeks, followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective ankle scoring system (Olerud and Molander scale) and by radiographic assessment of the ankle mortise.Results:At a mean follow-up of 13 months, the functional outcome score was 75. Excellent to good outcomes were noted in 83% of the patients. Ankle mortise was reduced in all cases, and all but one fibular fracture united without loss of fixation. Six patients had more than one malleolar injury, needing either screw or anchor fixations. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of the fibula. This was probably due to early screw removal, before union of the fibular fracture had occurred.Conclusion:We recommend syndesmosis-only fixation as an effective treatment option for a combination of syndesmosis disruption and Weber type-C lateral malleolar fractures.

Weber C ankle fractures with tibiofibular diastasis: syndesmosis-only fixation

“…infection, neurological damage, prominent metal work, peroneal tendonitis, nonunion and delayed union and hardware failure) that outweigh the benefits of such procedures. Mohammed et al 16 performed syndesmosis fixation alone in 12 patients with Weber-C ankle fractures with syndesmotic injury and reported good to excellent outcomes in 83% of these cases. As a result, syndesmosis-only fixation was recommended as an effective treatment option for the combination of syndesmosis disruption and Weber type-C lateral malleolar fractures.…”

Evaluation of Results of Extraperiosteal Plating of Pronation-Abduction Ankle Fractures in Adults

“…Extraperiosteal fixation techniques, which preserve the periosteum and indirectly reduce comminution, have been used for the treatment of other long bones. With the use of an extraperiosteal approach, the soft-tissue attachments to the fracture fragments are preserved,which maintains blood flow to promote healing and aids in obtaining the reduction 10,11 . Other methods of conventional treatments are conservative treatment using plaster cast immobilization, subperiosteal plating, pinning etc.…”

Acute and Chronic Injuries to the Syndesmosis

“…When applicable, fibular length must be assessed and corrected appropriately to facilitate anatomic reduction of the syndesmosis. 99 …”

“…117,[122][123][124][125] Two screws or locking plate fixation provides stronger mechanical fixation, 13,126 without translating into improved clinical outcomes. 99,127,128 Multiple screws are typically considered in Maisonneuve injuries, in obese patients, or in severely osteoporotic bone to increase construct stability. 129 If screw fixation is chosen, the authors' preference is a 3.5-mm tricortical screw if the fibula is fixated.…”