Flexible Fixation in Foot and Ankle Surgery

Raspovic, Katherine M.; Anigian, Kendall; Kapilow, Jaclyn; Tisano, Breann

doi:10.1016/j.cpm.2019.06.003

Cited by 1 publication

(1 citation statement)

References 34 publications

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“…Alternative methods for treatment of unstable syndesmotic injuries reported in literature include syndesmotic hooks or hook plates [45,160,166], transfixation bolts [162], various suture button constructs [5,8,38,94,95,106,117,120,131,132,141,142,165], ligament bracing [58,80,98,119,135,140], tendon autograft [25,56,91,98] or even allograft reconstruction [35]. During the last decades, several studies have clearly shown superior results after flexible dynamic syndesmotic stabilization compared to the use of syndesmotic screws with regard to accuracy of reduction, functional outcome, and even development of posttraumatic ankle arthritis [9,32,34,48,57,72,76,94,111,124,134,171].…”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Regauer¹,

Mackay

Nelson

et al. 2022

JCM

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Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

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