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

Abstract

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.

Characteristics and Effectiveness of Postoperative Rehabilitation Strategies in Ankle Fractures: A Systematic Review

“…42,50,54,55,57,60 Several studies reported patients being non-weight-bearing until fracture healing was confirmed with radiographic evidence. 49,51,56,57,60 Those studies that included separate cohorts with and without syndesmotic injury or repair 42,49,50,55 specified longer periods before full weight-bearing in patients with syndesmotic injury, usually 8-12 weeks compared with 4 to 6 weeks in patients without syndesmosis disruption.…”

Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and Reoperations as Compared With Screw Fixation: A Meta-analysis of Randomized Controlled Trials

“…Six were excluded because they were comparative studies without randomization, while 5 reports from clinicaltrials.gov were excluded because 1 RCT was ongoing at the time of the search, 1 was complete but with no report of the results, and 3 referred to RCTs already completed and published. So, after the application of inclusion and exclusion criteria, 7 studies 1,4,5,18,19,21,41 were included in the final analysis ( Figure 1).…”

“…3,14,17,23,28,31,42 However, the most recent meta-analysis—by Chen et al, 3 which comprised 9 studies and 387 patients—was seriously biased by the limited overall quality owing to the inclusion of prospective and retrospective studies with only 3 randomized controlled trials (RCTs). 4,18,19 The great interest in the treatment of syndesmotic injuries is confirmed by the fact that several new RCTs have been performed in Europe, 1,5,24 Canada, 27 and Asia 41 in the past few years.…”

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

“…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].…”