Effectiveness comparison of flexible fixation and rigid fixation in treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yuewei , ZHANG Minghui , LI Xiaorong ,  CHEN Xiaoyong , DENG Jianlong

Department of Orthopedics, Chenggong Hospital (PLA No. 174) Affiliated to Xiamen University, Xiamen Fujian, 361000, P.R.China;

Corresponding author：

CHEN Xiaoyong, Email: xm174cxy@hotmail.com

Keywords：

Distal tibiofibular syndesmosis; ankle fracture; flexible fixation; rigid fixation

DOI：

10.7507/1002-1892.201702050

Video：

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ObjectiveTo compare the effectiveness of flexible fixation and rigid fixation in the treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis.MethodsA retrospective analysis was made on the clinical data of 50 patients with ankle pronation-external rotation fractures and distal tibiofibular syndesmosis treated between January 2013 and December 2015. Suture-button fixation was used in 23 patients (flexible fixation group) and cortical screw fixation in 27 patients (rigid fixation group). There was no significant difference in age, gender, weight, side, fracture type, and time from trauma to surgery between 2 groups (P>0.05). The operation time, medial clear space (MCS), tibiofibular clear space (TFCS), tibiofibular overlap (TFO), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Disability Index (FADI) score were compared between 2 groups.ResultsThe operation time was (83.0±9.1) minutes in the flexible fixation group and was (79.6±13.1) minutes in the rigid fixation group, showing no significant difference (t=1.052, P=0.265). All patients achieved healing of incision by first intention. The patients were followed up 12-20 months (mean, 14 months). The X-ray films showed good healing of fracture in 2 groups. There was no screw fracture, delayed union or nounion. The fracture healing time was (12.1±2.5) months in the flexible fixation group and was (11.3±3.2) months in the rigid fixation group, showing no significant difference between 2 groups (t=1.024, P=0.192). Reduction loss occurred after removal of screw in 2 cases of the rigid fixation group. At last follow-up, there was no significant difference in MCS, TFCS, TFO, AOFAS score and FADI score between 2 groups (P>0.05).ConclusionSuture-button fixation has similar effectiveness to screw fixation in ankle function and imaging findings, and flexible fixation has lower risk of reduction loss of distal tibiofibular syndesmosis than rigid fixation.

Citation： LI Yuewei, ZHANG Minghui, LI Xiaorong, CHEN Xiaoyong, DENG Jianlong. Effectiveness comparison of flexible fixation and rigid fixation in treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 820-824. doi: 10.7507/1002-1892.201702050 Copy

1.	Warner SJ, Schottel PC, Hinds RM, et al. Fracture-dislocations demonstrate poorer postoperative functional outcomes among pronation external rotation IV Ankle Fractures. Foot Ankle Int, 2015, 36(6): 641-647.
2.	Van Heest TJ, Lafferty PM. Injuries to the ankle syndesmosis. J Bone Joint Surg (Am), 2014, 96(7): 603-613.
3.	Schepers T, van der Linden H, van Lieshout EM, et al. Technical aspects of the syndesmotic screw and their effect on functional outcome following acute distal tibiofibular syndesmosis injury. Injury, 2014, 45(4): 775-779.
4.	Kortekangas T, Savola O, Flinkkilä T, et al. A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography. Injury, 2015, 46(6): 1119-1126.
5.	Laflamme M, Belzile EL, Bédard L, et al. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma, 2015, 29(5): 216-223.
6.	Naqvi GA, Cunningham P, Lynch B, et al. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med, 2012, 40(12): 2828-2835.
7.	Maempel J, Ward A, Chesser T, et al. Use of tightrope fixation in ankle syndesmotic injuries. Chin J Traumatol, 2014, 17(1): 8-11.
8.	Anand A, Wei R, Patel A, et al. Tightrope fixation of syndesmotic injuries in Weber C ankle fractures: a multicentre case series. Eur J Orthop Surg Traumatol, 2017, 27: 461.
9.	Schnetzke M, Vetter SY, Beisemann N, et al. Management of syndesmotic injuries: What is the evidence? World J Orthop, 2016, 7(11): 718-725.
10.	Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop, 2012, 36(6): 1199-1206.
11.	van der Eng DM, Schep NW, Schepers T. Bioabsorbable Versus Metallic Screw Fixation for Tibiofibular Syndesmotic Ruptures: A Meta-Analysis. J Foot Ankle Surg, 2015, 54(4): 657-662.
12.	Andersen MR, Frihagen F, Madsen JE, et al. High complication rate after syndesmotic screw removal. Injury, 2015, 46(11): 2283-2287.
13.	Schepers T. To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg, 2011, 131(7): 879-883.
14.	Teramoto A, Suzuki D, Kamiya T, et al. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med, 2011, 39(10): 2226-2232.
15.	Seyhan M, Donmez F, Mahirogullari M, et al. Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures. Injury, 2015, 46 Suppl 2: S19-23.
16.	Solan MC, Davies MS, Sakellariou A. Syndesmosis Stabilisation: Screws Versus Flexible Fixation. Foot Ankle Clin, 2017, 22(1): 35-63.
17.	Schottel PC, Berkes MB, Little MT, et al. Comparison of clinical outcome of pronation external rotation versus supination external rotation ankle fractures. Foot Ankle Int, 2014, 35(4): 353-359.
18.	Little MM, Berkes MB, Schottel PC, et al. Anatomic Fixation of Supination External Rotation Type IV Equivalent Ankle Fractures. J Orthop Trauma, 2015, 29(5): 250-255.

1. Warner SJ, Schottel PC, Hinds RM, et al. Fracture-dislocations demonstrate poorer postoperative functional outcomes among pronation external rotation IV Ankle Fractures. Foot Ankle Int, 2015, 36(6): 641-647.
2. Van Heest TJ, Lafferty PM. Injuries to the ankle syndesmosis. J Bone Joint Surg (Am), 2014, 96(7): 603-613.
3. Schepers T, van der Linden H, van Lieshout EM, et al. Technical aspects of the syndesmotic screw and their effect on functional outcome following acute distal tibiofibular syndesmosis injury. Injury, 2014, 45(4): 775-779.
4. Kortekangas T, Savola O, Flinkkilä T, et al. A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography. Injury, 2015, 46(6): 1119-1126.
5. Laflamme M, Belzile EL, Bédard L, et al. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma, 2015, 29(5): 216-223.
6. Naqvi GA, Cunningham P, Lynch B, et al. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med, 2012, 40(12): 2828-2835.
7. Maempel J, Ward A, Chesser T, et al. Use of tightrope fixation in ankle syndesmotic injuries. Chin J Traumatol, 2014, 17(1): 8-11.
8. Anand A, Wei R, Patel A, et al. Tightrope fixation of syndesmotic injuries in Weber C ankle fractures: a multicentre case series. Eur J Orthop Surg Traumatol, 2017, 27: 461.
9. Schnetzke M, Vetter SY, Beisemann N, et al. Management of syndesmotic injuries: What is the evidence? World J Orthop, 2016, 7(11): 718-725.
10. Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop, 2012, 36(6): 1199-1206.
11. van der Eng DM, Schep NW, Schepers T. Bioabsorbable Versus Metallic Screw Fixation for Tibiofibular Syndesmotic Ruptures: A Meta-Analysis. J Foot Ankle Surg, 2015, 54(4): 657-662.
12. Andersen MR, Frihagen F, Madsen JE, et al. High complication rate after syndesmotic screw removal. Injury, 2015, 46(11): 2283-2287.
13. Schepers T. To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg, 2011, 131(7): 879-883.
14. Teramoto A, Suzuki D, Kamiya T, et al. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med, 2011, 39(10): 2226-2232.
15. Seyhan M, Donmez F, Mahirogullari M, et al. Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures. Injury, 2015, 46 Suppl 2: S19-23.
16. Solan MC, Davies MS, Sakellariou A. Syndesmosis Stabilisation: Screws Versus Flexible Fixation. Foot Ankle Clin, 2017, 22(1): 35-63.
17. Schottel PC, Berkes MB, Little MT, et al. Comparison of clinical outcome of pronation external rotation versus supination external rotation ankle fractures. Foot Ankle Int, 2014, 35(4): 353-359.
18. Little MM, Berkes MB, Schottel PC, et al. Anatomic Fixation of Supination External Rotation Type IV Equivalent Ankle Fractures. J Orthop Trauma, 2015, 29(5): 250-255.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of flexible fixation and rigid fixation in treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis

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