Outcome after fixation of ankle fractures with an injury to the syndesmosis

Abstract

The purpose of this study was to compare the clinical and radiological outcome of patients with intact, broken and removed syndesmosis screws after Weber B or C ankle fracture with an associated injury to the syndesmosis. We hypothesised that there would be no difference. Of a possible 142 patients who fulfilled our inclusion criteria, 52 returned for clinical and radiological assessment at least one year after surgery. Of these, 27 had intact syndesmosis screws, ten had broken screws, and 15 had undergone elective removal of the screw. The mean American Orthopaedic Foot and Ankle Society ankle/hindfoot score was 83.07 (sd 13.59) in the intact screw group, 92.40 (sd 12.69) in the broken screw group, and 85.80 (sd 11.33) in the removed screw group (p = 0.0466). There was no difference in clinical outcome of patients with intact or removed syndesmotic screws. Paradoxically, patients with a broken syndesmosis screw had the best clinical outcome. Our data do not support the removal of intact or broken syndesmosis screws, and we caution against attributing post-operative ankle pain to breakage of the syndesmosis screw.

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function

“…The widening increased at an average of 3.8 mm (range 3-7 mm). An unreduced SD has been reported to compromise ankle function [10,26].…”

Complications of Syndesmotic Screw Removal

“…Complications recorded were: 1) minor or major wound infection, 2) recurrent syndesmotic diastasis secondary to removal of the syndesmotic screw, and 3) removal of a broken screw. Concerning the latter, a broken screw was not considered a complication in itself, however detection of a broken screw at surgery was considered a complication, as removal would subject patients to potential surgical and anaesthetics risk, without contributing to an additional improvement in motion or outcome 8,23 , making the removal procedure superfluous. Recurrent diastasis was defined as widening of the syndesmosis of more than 2 mm compared with radiographs taken shortly after the first operation, in which the fracture was fixed, or a widening of the medial clear space of more than 2 mm compared with the distance between the tibia plafond (pilon) and talus.…”

Intraoperative 3‑D-Röntgenkontrolle bei Verletzungen des Fußes und des Sprunggelenks

“…Die knöcherne Stellung im Bereich der Sprunggelenkgabeln kann hierdurch jedoch nur unzureichend beurteilt werden [22]. Postoperativ sind die interessierenden Strukturen am besten durch eine Computertomographie (CT) darzustellen [18,19,23,24]. Eine dreidimensionale knöcherne Abbildung der distalen Fibula als Maß für die Reposition der Fibula gelingt im Operationssaal am zuverlässigsten mit dem 3-D-fähigen C-Bogen (.…”