Functional outcomes following syndesmotic fixation: A comparison of screws retained in situ versus routine removal – Is it really necessary?

Tucker, Adam; Street, Julia; Kealey, David; McDonald, Sinead; Stevenson, Mike

doi:10.1016/j.injury.2013.08.011

Cited by 81 publications

(82 citation statements)

References 28 publications

(34 reference statements)

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“…The authors advocate that syndesmosis screws be left in situ and should only be removed in case of symptomatic implants beyond 6 months postoperatively. 13 Kortekangas et al in 2014 in their study compared the functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation ankle fractures with intraoperatively confirmed syndesmosis disruption. 13 patients underwent syndesmotic screw fixation while 11 did not.…”

Section: Inferencementioning

confidence: 99%

Functional Outcome Following Operative Treatment of Ankle Fractures

D'Almeida¹,

Thomas²,

Devasia³

et al. 2015

jemds

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Section: Inferencementioning

confidence: 99%

Functional Outcome Following Operative Treatment of Ankle Fractures

D'Almeida¹,

Thomas²,

Devasia³

et al. 2015

jemds

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“…Gennis et al found that the mortise remained intact and found no tibiafibula diastasis after weight bearing regardless of the syndesmotic screws were removed, loosened, or remain solid and in place [49]. Tucker et al found similar results in functional outcomes and advocated that the syndesmotic screws be left unless the patients continued to have stiffness greater than 6 months postoperatively [11]. In contrast, Song et al had eight of nine (89%) patients with malreduced syndesmoses that demonstrated adequate reduction of tibiofibular syndesmosis after syndesmosis screw removal [50].…”

Section: Operative Treatment For Isolated Syndesmotic Injuriesmentioning

confidence: 99%

“…This is especially troublesome when considering that this injury is most prevalent between the ages of 18 and 34 [1]. Non-isolated injury to the syndesmosis has been reported to be associated with 8.5% of all ankle injuries [8], although studies have documented up to 25% of operatively treated ankle fractures being identified with unstable syndesmosis injuries, most commonly occurring in Weber type C injuries [9][10][11].…”

Section: Epidemiologymentioning

confidence: 99%

“…Non-isolated syndesmotic injuries with associated distal fibular fractures are common, particularly in the presence of Weber B and more often Weber C ankle fractures [11,57,76,77]. Gill et al found that in SER IV (Weber B) ankle fractures, the rate of revision fixation secondary to syndesmotic diastasis was 5% of all fractures that did not have a syndesmosis screw in the primary fixation [77].…”

Section: Treatment Of Non-isolated Syndesmotic Injuriesmentioning

confidence: 99%

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Current trends in the diagnosis and management of syndesmotic injury

Vopat

Lubberts

et al. 2017

Curr Rev Musculoskelet Med

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Ideal management of the various presentations of syndesmotic injury remains controversial to this day. High quality evidentiary science on this topic is rare, and numerous existing studies continue to contradict one another. The primary reasons for these discrepancies are that previous studies have failed to (1) properly distinguish between isolated (nonfractured) and non-isolated injuries, (2) accurately define stable from unstable injuries, and (3) sufficiently differentiate between acute and chronic injuries. The purpose of this review is to summarize today's body of literature regarding diagnosis and management of syndesmotic injury and discuss current trends and important future directions to optimize care of this very heterogeneous population.

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“…In addition, Miller et al showed that postoperative ankle function improved slightly after the removal of screws for fixation of a distal tibiofibular syndesmosis 24 . In addition, clinical data have shown that screw position in 22%-52% of patients who undergo distal tibiofibular syndesmosis fixation is not accurate, which may lead to decreased range of motion in the ankle [25][26][27] . In 2015, a study by Schottel et al revealed that deltoid ligament repair may be an alternative approach for screw fixation of the distal tibiofibular syndesmosis 28 .…”

Section: Management Of the Distal Tibiofibular Syndesmosismentioning

confidence: 99%

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination‐External Rotation Type IV Ankle Fractures

Wang

Zhang

Yin

et al. 2017

Orthopaedic Surgery

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Objective: To investigate the effect of internal fixation on postoperative ankle function in patients with supinationexternal rotation type IV ankle fractures, including medial malleolus fractures and deltoid ligament injury.Methods: Between January 2012 and June 2014, patients with medial structure injuries were enrolled in this study and assigned to the medial malleolus fracture group or the deltoid ligament group. The surgical procedures for the two groups were documented. The follow-up endpoint was the time point when the steel plate or screw was removed from the lateral ankle. The Olerud-Molander ankle scoring system was used to assess ankle function.Results: A total of 84 patients with supination-external rotation type IV ankle fractures had complete medical records and were included in this study. The average age of the patients was 44.16 years (range, 15-75). The patient sample included 39 males and 45 females. Overall, 49 patients (19 males and 30 females) suffered a medial malleolus fracture. The average age of these patients was 40.20 years (range, 15-75). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 81.6% (40 patients) of these patients. Overall, 35 patients (20 males and 15 females) experienced a deltoid ligament injury. The average age of these patients was 44.21 years (range, 17-73). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 11.5% (four patients) of these patients. Open reduction was performed in patients with medial malleolus fractures, and two 4.0-mm cannulated screws were used to fixate the posterior malleolus and the medial malleolus. The sutureanchor technique was used to repair the ligaments in patients with deltoid ligament injuries. The follow-up endpoint was the time point when the steel plate and screws were removed from the lateral ankle in patients. The average follow-up period was 13.4 months (range, 11-17). The Olerud-Molander ankle scoring system was used to assess postoperative ankle function. The average score for the patients in the medial malleolus fracture group was 90.3 points (range, 85-95). The average score for the patients in the deltoid ligament injury group was 87.7 points (range, 80-95). No significant differences were found in the scores between the two groups. Conclusion:Medial malleolus fracture and deltoid ligament injury are two different presentations of supinationexternal rotation type IV ankle fractures. Anatomic reduction of the articular surface concurrent with restoration of ankle stability can achieve favorable results for these two injuries.

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Functional outcomes following syndesmotic fixation: A comparison of screws retained in situ versus routine removal – Is it really necessary?

Cited by 81 publications

References 28 publications

Functional Outcome Following Operative Treatment of Ankle Fractures

Functional Outcome Following Operative Treatment of Ankle Fractures

Current trends in the diagnosis and management of syndesmotic injury

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination‐External Rotation Type IV Ankle Fractures

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