Untreated small posterior fragment of ankle fracture with early removal of syndesmotic screw is associated with recurrent syndesmotic instability |
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| Institution: | 1. Division of Orthopaedic Trauma;2. Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, 201, Sec.2, Shih-Pai Rd. Taipei 112, Taiwan;3. Department of Orthopaedics, School of Medicine, National Yang-Ming University;4. Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital;5. Department of Radiology, School of Medicine, National Yang-Ming University;1. Department of Orthopaedics, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan;2. Department of Orthopaedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;3. Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;4. Department of Orthopaedics, Show Chwan Memorial Hospital, Changhua, Taiwan;5. Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan;6. Division of Traumatology, National Cheng Kung University Medical Center, College of Medicine, Tainan, Taiwan;7. Department of Statistics, National Cheng Kung University, Tainan, Taiwan;1. Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China;2. Department of Hand and Upper Extremity Surgery, Jing'' an District Central Hospital, Shanghai, China;3. Department of Ultrasound in Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China;4. Limb Function Reconstruction Center, Jing'' an District Central Hospital, Shanghai, China;5. National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China;6. Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China;7. Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China |
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| Abstract: | IntroductionThis retrospective study aimed to report outcomes of fixation of bi-malleolar or tri-malleolar fractures combined with syndesmotic injury with or without posterior malleolar fracture (PMF), and to ascertain whether syndesmotic screw removal at 6 to 8 weeks or 3 months postoperatively is more beneficial.MethodsWe retrospectively reviewed patients who received open reduction and internal fixation for bi-malleolar (without PMF) or tri-malleolar ankle fracture (with PMF) with syndesmotic injury between January 2013 and December 2017 with at least 24 months of postoperative follow-up. All patients suffered syndesmotic instabilities and were treated using a syndesmotic screw without PMF fixation. Patients with bi-malleolar fracture with syndesmotic screw removal at 6 to 8 weeks postoperatively were included in Group I, tri-malleolar fracture with syndesmotic screw removal at 6 to 8 weeks in Group II, and tri-malleolar fracture with syndesmotic screw removal at 3 months in Group III. Demographic data, clinical and radiographic outcomes were analyzed.ResultsA total of 113 patients were included (Group I, n=47; Group II, n=43; Group III, n=23). Average size of PMF was 14% in patients with tri-malleolar fractures (Groups II and III). No significant difference in ankle functional outcome among groups was observed. The recurrence rate of syndesmotic instability was 10.6% in Group I, 20.9% in Group II, and 8.7% in Group III. Although the difference in recurrence rates of syndesmotic instability among three groups was not statistically significant (P=0.264), Group II showed more interval change in tibiofibular clear space between initial postoperative radiographs and last follow-up radiographs (P=0.028) compared to the other two groups. Fracture union was achieved in all patients without screw breakage.ConclusionWe suggest that the better timing for syndesmotic screw removal is 3 months, instead of 6 to 8 weeks postoperatively, to reduce the risk of recurrence of syndesmotic instability for tri-malleolar fracture without posterior fragment fixation.Level of EvidenceLevel III- Case-control study. |
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