Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: A prospective and comparative study |
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| Affiliation: | 1. The Orthopaedic Trauma Unit, Division of Orthopaedics, University of Alabama at Birmingham, United States;2. Talpiot Medical Leadership Program, Sheba Medical Centre, Israel;1. Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, PR China;2. Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China;1. Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg/Saar, Germany;2. Institute for Clinical & Experimental Surgery, University of Saarland, Homburg/Saar, Germany;1. Ilizarov Unit S.C Ortopedia e Traumatologia, Manzoni Hospital, Lecco, Italy;2. Department of Orthopedic and Trauma, Postgraduate Medical Institute Hayatabad, Medical Complex, Peshawar, Pakistan |
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| Abstract: | PurposeSyndesmosis injury is common in external-rotation type ankle fractures (ERAF). Trans-syndesmosis screw fixation, the gold-standard treatment, is currently controversial for its complications and biomechanical disadvantages. The purpose of this study was to introduce a new method of anatomically repairing the anterior-inferior tibiofibular ligament (AITFL) and augmentation with anchor rope system to treat the syndesmotic instability in ERAF with posterior malleolus involvement and to compare its clinical outcomes with that of trans-syndesmosis screw fixation.Methods53 ERAFs with posterior malleolus involvement received surgery, and the syndesmosis was still unstable after fracture fixation. They were randomised into screw fixation group and AITFL anatomical repair with augmentation group. Reduction quality, syndesmosis diastasis recurrence, pain (VAS score), time back to work, Olerud–Molander ankle score and range of motion (ROM) of ankle were investigated.ResultsOlerud–Molander score in AITFL repair group and screw group was 90.4 and 85.8 at 12-month follow-up (P > 0.05). Plantar flexion was 31.2° and 34.3° in repair and screw groups (P = 0.04). Mal-reduction happened in 5 cases (19.2%) in screw group while 2 cases (7.4%) in repair group. Postoperative syndesmosis re-diastasis occurred in 3 cases in screw group while zero in repair group (P > 0.05). Pain score was similar between the two groups (P > 0.05). Overall complication rate and back to work time were 26.9% and 3.7% (P = 0.04), 7.15 months and 5.26 months (P = 0.02) in screw group and repair group, respectively.ConclusionsFor syndesmotic instability in ERAF with posterior malleolus involvement, the method of AITFL anatomical repair and augmentation with anchor rope system had an equivalent functional outcome and reduction, earlier rehabilitation and less complication compared with screw fixation. It can be selected as an alternative. |
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| Keywords: | Ankle joint Bone fractures Ankle injuries Internal fixation Syndesmotic injuries Tibiofibular syndesmosis |
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