TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUBenwen ,  DINGZhenqi , HUANGGuofeng , LIUGuojun , CAIZhemin , DINGLuobin , LIXiang

The Center of Orthopaedics and Traumatology, the 175 th Hospital of Chinese PLA, Zhangzhou Fujian, 363000, P. R. China;

Corresponding author：

DINGZhenqi, Email: dzqi@xmu.edu.cn

Keywords：

Ankle fracture; Pronation external rotation; Distal tibiofibular syndesmosis; Screw; Internal fixation

DOI：

10.7507/1002-1892.20160220

Video：

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Objective To evaluate the difference between using and not using syndesmotic screw to treat pronation external rotation (PER) ankle fracture combined with separation of distal tibiofibular syndesmosis. Methods Between April 2011 and October 2014, 46 cases of PER ankle fracture combined with separation of distal tibiofibular syndesmosis were treated, and syndesmotic screw was used in 24 cases (fixation group) and syndesmotic screw was not used in 22 cases (non-fixation group). There was no significant difference in gender, age, weight, cause of injury, side, injury to operation time, and fracture type between 2 groups (P > 0.05). The time for full weight-bearing, fracture healing time, and complications were recorded after operation. Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap (TBOL) and tibiofibular clear space (TBCS). Baird-Jackson score was used to evaluate functional recovery of the ankle. Results All incision healed by first intention without complications. The cases were followed up 13-18 months (mean, 15.2 months) in 2 groups. The time for full weight-bearing was 8-12 weeks (median, 11 weeks) in fixation group, which was significantly later than that in non-fixation group (range, 6-10 weeks; median, 8 weeks) (Z=-5.049, P=0.000). X-ray examination showed reduction of separation of distal tibiofibular syndesmosis. All fractures healed. The fracture healing time was (13.83±1.37) weeks in fixation group, and was (13.91±1.31) weeks in non-fixation group, showing no significant difference (t=-0.191, P=0.945). No separation of distal tibiofibular syndesmosis, delayed union, nonunion, loosening, or breakage of fixation devices was observed in 2 groups. There was no significant difference in TBOL, TBCS, Baird-Jackson score and the excellent and good rate between 2 groups (P > 0.05). Conclusion If the medial, lateral, and posterior structures of the ankle could be repaired according to injury, no significant influence on functional outcome of ankle or radiologic findings could be detected whether syndesmotic fixation is given or not in treating PER ankle fracture (exclude Maisonneuve fracture) combined with separation of distal tibiofibular syndesmosis.

Citation： WUBenwen, DINGZhenqi, HUANGGuofeng, LIUGuojun, CAIZhemin, DINGLuobin, LIXiang. TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1081-1084. doi: 10.7507/1002-1892.20160220 Copy

1.	van den Bekerom MP, Kloen P, Luitse JS, et al. Complications of distal tibiofibular syndesmotic screw stabilization:analysis of 236 patients. J Foot Ankle Surg, 2013, 52(4):456-459.
2.	张述才, 杨晶, 杨广忠, 等.踝关节骨折切开复位内固定后下胫腓联合分离固定和未固定的疗效比较.中国骨与关节损伤杂志, 2014, 29(10):1006-1008.
3.	Jones CR, Nunley JA 2nd. Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures. J Orthop Trauma, 2015, 29(5):245-249.
4.	De Vries JS, Wijgman AJ, Sierevelt IN, et al. Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg, 2005, 44(3):211-217.
5.	Tang CW, Roidis N, Vaishnav S, et al. Position of the distal fibular fragment in pronation and supination ankle fractures:a CT evaluation. Foot Ankle Int, 2003, 24(7):561-566.
6.	Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am), 1976, 58(3):356-357.
7.	Beumer A, Valstar ER, Garling EH, et al. Kinematics of the distal tibiofibular syndesmosis:radiosterometry in 11 normal ankles. Acta Orthop Scand, 2003, 74(3):337-343.
8.	Huber T, Schmoelz W, Bölderl A. Motion of the fibula relative to the tibia and its alterations with syndesmosis screws:A cadaver study. Foot Ankle Surg, 2012, 18(3):203-209.
9.	Liu Q, Zhao G, Yu B, et al. Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle:a finite element study. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4):1228-1235.
10.	Hamid N, Loeffler BJ, Braddy W, et al. Outcome after fixation of ankle fractures with an injury to the syndesmosis:the effect of the syndesmosis screw. J Bone Joint Surg (Br), 2009, 91(8):1069-1073.
11.	Kaftandziev I, Spasov M, Trpeski S, et al. Fate of the syndesmotic screw-Search for a prudent solution. Injury, 2015, 46 Suppl 6:S125-129.
12.	Kortekangas TH, Pakarinen HJ, Savola O, et al. Syndesmotic fixation in supination-external rotation ankle fractures:a prospective randomized study. Foot Ankle Int, 2014, 35(10):988-995.
13.	王海鹏, 顾峥嵘, 刘云吉, 等.手术治疗踝关节骨折伴三角韧带损伤的疗效观察.中国修复重建外科杂志, 2015, 29(4):416-419.
14.	Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma, 2015, 29(12):574-578.
15.	何勇, 顾湘杰, 马昕, 等.胫腓下联合分离的生物力学研究.中华创伤骨科杂志, 2005, 7(10):943-947.
16.	Schepers T, Van Lieshout EM, de Vries MR, et al. Complications of syndesmotic screw removal. Foot Ankle Int, 2011, 32(11):1040-1044.
17.	Miller AN, Barei DP, Iaquinto JM, et al. Iatrogenic syndesmosis malreduction via clamp and screw placement. J Orthop Trauma, 2013, 27(2):100-106.
18.	Westermann RW, Rungprai C, Goetz JE, et al. The effect of suture-button fixation on simulated syndesmotic malreduction:a cadaveric study. J Bone Joint Surg (Am), 2014, 96(20):1732-1738.
19.	Song DJ, Lanzi JT, Groth AT, et al. The effect of syndesmosis screw removal on the reduction of the distal tibiofibular joint:a prospective radiographic study. Foot Ankle Int, 2014, 35(6):543-548.

1. van den Bekerom MP, Kloen P, Luitse JS, et al. Complications of distal tibiofibular syndesmotic screw stabilization:analysis of 236 patients. J Foot Ankle Surg, 2013, 52(4):456-459.
2. 张述才, 杨晶, 杨广忠, 等.踝关节骨折切开复位内固定后下胫腓联合分离固定和未固定的疗效比较.中国骨与关节损伤杂志, 2014, 29(10):1006-1008.
3. Jones CR, Nunley JA 2nd. Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures. J Orthop Trauma, 2015, 29(5):245-249.
4. De Vries JS, Wijgman AJ, Sierevelt IN, et al. Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg, 2005, 44(3):211-217.
5. Tang CW, Roidis N, Vaishnav S, et al. Position of the distal fibular fragment in pronation and supination ankle fractures:a CT evaluation. Foot Ankle Int, 2003, 24(7):561-566.
6. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am), 1976, 58(3):356-357.
7. Beumer A, Valstar ER, Garling EH, et al. Kinematics of the distal tibiofibular syndesmosis:radiosterometry in 11 normal ankles. Acta Orthop Scand, 2003, 74(3):337-343.
8. Huber T, Schmoelz W, Bölderl A. Motion of the fibula relative to the tibia and its alterations with syndesmosis screws:A cadaver study. Foot Ankle Surg, 2012, 18(3):203-209.
9. Liu Q, Zhao G, Yu B, et al. Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle:a finite element study. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4):1228-1235.
10. Hamid N, Loeffler BJ, Braddy W, et al. Outcome after fixation of ankle fractures with an injury to the syndesmosis:the effect of the syndesmosis screw. J Bone Joint Surg (Br), 2009, 91(8):1069-1073.
11. Kaftandziev I, Spasov M, Trpeski S, et al. Fate of the syndesmotic screw-Search for a prudent solution. Injury, 2015, 46 Suppl 6:S125-129.
12. Kortekangas TH, Pakarinen HJ, Savola O, et al. Syndesmotic fixation in supination-external rotation ankle fractures:a prospective randomized study. Foot Ankle Int, 2014, 35(10):988-995.
13. 王海鹏, 顾峥嵘, 刘云吉, 等.手术治疗踝关节骨折伴三角韧带损伤的疗效观察.中国修复重建外科杂志, 2015, 29(4):416-419.
14. Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma, 2015, 29(12):574-578.
15. 何勇, 顾湘杰, 马昕, 等.胫腓下联合分离的生物力学研究.中华创伤骨科杂志, 2005, 7(10):943-947.
16. Schepers T, Van Lieshout EM, de Vries MR, et al. Complications of syndesmotic screw removal. Foot Ankle Int, 2011, 32(11):1040-1044.
17. Miller AN, Barei DP, Iaquinto JM, et al. Iatrogenic syndesmosis malreduction via clamp and screw placement. J Orthop Trauma, 2013, 27(2):100-106.
18. Westermann RW, Rungprai C, Goetz JE, et al. The effect of suture-button fixation on simulated syndesmotic malreduction:a cadaveric study. J Bone Joint Surg (Am), 2014, 96(20):1732-1738.
19. Song DJ, Lanzi JT, Groth AT, et al. The effect of syndesmosis screw removal on the reduction of the distal tibiofibular joint:a prospective radiographic study. Foot Ankle Int, 2014, 35(6):543-548.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS

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