No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures

Wikerøy, Annette K. B.; Høiness, Per R.; Andreassen, Geir S.; Hellund, Johan C.; Madsen, Jan Erik

Affiliations

¹Orthopaedic Center, Ullevål University Hospital, Oslo, Norway

²Orthopaedic Center, Rikshospitalet, The National Hospital, Oslo, Norway

³Radiologic Center, Ullevål University Hospital, Oslo, Norway

Abstract and keywords

Objective: To assess long-term functional and radiologic results after two types of syndesmosis fixation, comparing one quadricortical syndesmotic screw fixation with two tricortical screw fixation in ankle fractures.

Design: Follow up of a previously conducted prospective, randomized clinical study.

Setting: University clinic, Level I trauma center.

Patients: Forty-eight patients with closed ankle fractures and concomitant syndesmotic rupture were operated on with quadricortical (n = 23) or tricortical (n = 25) syndesmotic fixation.

Results: Follow-up time was 8.4 years (range, 7.7-8.9 years). There were no statistical differences in the two groups regarding Olerud-Molander Ankle score, Orthopaedic Trauma Association score, or degree of osteoarthritis. Patients with a difference in the syndesmotic width between the operated and the nonoperated ankle of 1.5 mm or more showed a tendency toward poorer functional results (P = 0.056). Twenty-one patients showed synostosis on plain radiographs. Of these, only seven patients had synostosis verified on computed tomography, all of whom had significantly worse function. Patients with a posterior fracture fragment at time of operation had poorer Olerud-Molander Ankle score (73.1 versus 85, P = 0.05) and all had osteoarthritis as compared with 55% of those without a posterior fragment. Obese patients (body mass index greater than 30 kg/m2) also had poorer Orthopaedic Trauma Association score, but neither obesity nor being overweight predicted late arthritis.

Conclusions: Follow up 8.4 years after surgery of ankle fractures with syndesmotic injury showed satisfactory functional results with only minor differences between the two groups of syndesmotic fixation. Obese patients had significantly poorer functional results. The presence of a posterior fracture fragment was an important negative prognostic factor regarding functional results. Plain radiographs overestimated tibiofibular synostosis. Synostosis on computed tomography, however, predicted impaired ankle function. A difference in syndesmotic width 1.5 mm or greater between the two ankles seemed to be associated with an inferior clinical result.

Keywords: ankle fracture, syndesmosis, screw fixation, function, long time follow up, synostosis, ankle injury, ankle instability, syndesmotic screw, quadricortical, tricortical

Links

DOI: 10.1097/BOT.0b013e3181bedca1

PubMed: 20035173

WoS: 000273158000005

History

Accepted: 2009-08-31

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Cited By (6)

Year	Entry
2013	Hunt KJ. Syndesmosis injuries. Curr Rev Musculoskel Med. December 2013;6(4):304-312.
2012	Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle syndesmotic injuries: comparison of TightRope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. December 2012;40(12):2828-2835.
2011	Schepers T. To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg. July 2011;131(7):879-883.
2011	Pakarinen HJ, Flinkkilä TE, Ohtonen PP, Hyvönen PH, Lakovaara MT, Leppilahti JI, Ristiniemi JY. Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study. Foot Ankle Int. December 2011;32(12):1103-1109.
2012	Schepers T, Zuuren WJv, Bekerom MPJvd, Vogels LMM, Lieshout EMMv. The management of acute distal tibio-fibular syndesmotic injuries: results of a nationwide survey. Injury. October 2012;43(10):1718-1723.
2012	Franke J, von Recum J, Suda AJ, Grützner PA, Wendl K. Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries. J Bone Joint Surg. August 2012;94A(15):1386-1390.