Efficacy and endurability of tricortical syndesmotic screw fixation in ankle fractures: a clinical prospective study
Keywords:Ankle fractures, Syndesmotic injuries, Tricortical fixation
Background: Ankle fractures represent 10% of all fractures with an incidence of around 137/105 population per year. These fractures are most of the times associated with syndesmotic injuries due to rotation of the limb with foot fixed/axial loading as a result of high velocity injuries. The syndesmosis is ruptured as a result of a torsional movement of the talus or as a result of a severe abduction force. Diastasis requires the rupture of three strong ligaments and the interosseous membrane and therefore represents a very substantial insult to the ankle at tibio-fibular joint and requires fixation. A syndesmosis screw through fibular plate prevents normal movement between the distal tibia and the fibula to allow healing and stability. Tricortical fixation provides more endurability during axial loading and ankle movements while walking. The present clinical prospective study was carried out with an aim to evaluate the efficacy and endurability of tricortical fixation of syndesmotic injuries, by one 3.5 mm screw through fibular plate.
Methods: The present clinical prospective study was carried out at a tertiary institute of Punjab on 50 IPD patients admitted through emergency/outdoor patient department.
Results: The 70% of the cases with surgical fixation of diastasis of syndesmosis gained normal range of motion at ankle joint after six weeks of immobilization in plaster of Paris (POP) back slab.
Conclusions: Tricortical fixation of syndesmotic injuries, by one 3.5 mm screw through fibular plate is a must as it provides stability and endurability during axial loading and ankle movements while walking.
Court-Brown CM, McBirnie J. Adult ankle fractures-an increasing problem? Acta Orthop. 1998;69(1):43-7.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–697. 4596 76
Daly PJ, Fitzgerald RH, Melton LJ. Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand. 1987;58(5):539-44
Bugler KE, Clement ND, Duckworth AD, et al. Open ankle fractures: who gets them and why? Arch Orthop Trauma Surg. 2015;135(3):297-303.
Albers GH, Kort AF, Middendorf Prjm, Et Al. Distal tibiofibular synostosis after ankle fracture: a 14-year follow-up study. J Bone Joint Surg Br. 1996;78: 250.
Chissell Hr, Jones J: The influence of a diastasis screw on the outcome of Weber type-C ankle fractures. J Bone Joint Surg Br. 1995;77:435.
Hoiness P, Stromsoe K. Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomised study comparing two methods of syndesmosis fixation. J Orthop Trauma. 2004;18(6):331-37.
Coles CP, Tornetta P, Obremskey WT. Ankle fractures: an expert survey of orthopaedic trauma association members and evidence-based treatment recommendations. J Orthop Trauma. 2019;33(9):e318-24.
McBryde A, Chiasson B, Wilhelm A, Donovan F, Ray T, Bacilla P. Syndesmotic screw placement: a biomechanical analysis. Foot Ankle Int. 1997;18(5):262-6.
Rano JA, Savoy-Moore RT, Fallat LM. Strength comparison of allogenic bone screws, bioabsorbable screw and stainless steelscrew fixation through fibular plate. J Foot Ankle Surg. 2002;41(1):6-15.
Bava E, Charlton T, Thordarson D. Ankle fracture syndesmosis fixation and management: the current practice of orthopedic surgeons. Am J Orthop (Belle Mead, NJ). 2010;39(5):242-6.
Xenos JS, Hopkinson WJ, Mulligan ME. The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am. 1995;77(6):847-56.
Kwon JY, Campbell JT, Myerson MS. Posterior tibial tendon tear after 4-cortex syndesmotic screw fixation through fibular plate: a case report and literature review. J Orthop Trauma. 2012;26(6):e66-9.
McBryde A, Chiasson B, Wilhelm A. Syndesmotic screw placement: a biomechanical analysis. Foot Ankle Int. 1997;18(5):262-6.
Olerud C. The effect of the syndesmotic screw on the extension capacity of the ankle joint. Arch Orthop Trauma Surg. 1985;104(5):299-302.
Schepers T, De Vries MR, Van Lieshout EM. The timing of ankle fracture surgery and the effect on infectious complications: a case series and systematic review of the literature. Int Orthop. 2013;37(3):489-94.
Mont MA, Sedlin ED, Weiner LS. Postoperative radiographs as predictors of clinical outcome in unstable ankle fractures. J Orthop Trauma. 1992;6(3):352-7.
Asloum Y, Bedin B, Roger T. Internal fixation of the fibula in ankle fractures: a prospective, randomized and comparative study: plating versus nailing. Orthop Traumatol Surg Res. 2014;100(4):S255-59.
White TO, Bugler KE, Appleton P. A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients. Bone Joint J. 2016;98B(9):1248-52.
Beauchamp CG, Clay NR, Thexton PW. Displaced ankle fractures in patients over 50 years of age. Bone Joint Surg Br. 1983;65(3):329-32.
Salai M, Dudkiewicz I, Novikov I. The epidemic of ankle fractures in the elderly: is surgical treatment warranted? Arch Orthop Trauma Surg. 2000;120(9):511-3.
Stufkens SA, Knupp M, Horisberger M. Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Br. 2010;92(2):279-86.
Hintermann B, Regazzoni P, Lampert C. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br. 2000;82(3):345-51.