Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation

Background Fixation of unstable ankle fractures, including fixation of posterior malleolus fracture fragments with the attached, intact posteroinferior tibiofibular ligament (PITFL), reportedly provides more stable fixation than transsyndesmotic screws. Questions/Purposes To confirm this observation...

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Bibliographic Details
Published in:Clinical orthopaedics and related research 2010-04, Vol.468 (4), p.1129-1135
Main Authors: Miller, Anna N., Carroll, Eben A., Parker, Robert J., Helfet, David L., Lorich, Dean G.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Ankle Injuries - diagnostic imaging
Ankle Injuries - pathology
Ankle Injuries - surgery
Biological and medical sciences
Biomechanical Phenomena - physiology
Bone Screws
Clinical Research
Conservative Orthopedics
Diseases of the osteoarticular system
Female
Fracture Fixation, Internal - instrumentation
Fracture Fixation, Internal - methods
Fractures, Bone - pathology
Fractures, Bone - surgery
Humans
Internal Fixators
Ligaments, Articular - diagnostic imaging
Ligaments, Articular - pathology
Ligaments, Articular - surgery
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Orthopedics
Outcome and Process Assessment (Health Care)
Prospective Studies
Radiography
Range of Motion, Articular
Recovery of Function
Sports Medicine
Surgery
Surgical Orthopedics
Tendon Injuries - diagnostic imaging
Tendon Injuries - pathology
Tendon Injuries - surgery
Treatment Outcome
Young Adult
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Summary:Background Fixation of unstable ankle fractures, including fixation of posterior malleolus fracture fragments with the attached, intact posteroinferior tibiofibular ligament (PITFL), reportedly provides more stable fixation than transsyndesmotic screws. Questions/Purposes To confirm this observation we compared the Foot and Ankle Outcome Score (FAOS) and radiographic maintenance of fixation for fractures treated through direct posterior malleolar fixation versus syndesmotic screw fixation. Methods We prospectively followed 31 one patients with unstable ankle fractures treated with (1) open posterior malleolus fixation whenever the posterior malleolus was fractured, regardless of fragment size (PM group; n = 9); (2) locked syndesmotic screws in the absence of a posterior malleolar fracture (S group; n = 14); or (3) combined fixation in fracture-dislocations and more severe soft tissue injury (C group; n = 8). All patients had preoperative MRI confirming syndesmotic injury and an intact PITFL; postoperative and followup radiographs were evaluated for syndesmotic congruence. The minimum followup was 12 months (mean, 15 months; range, 12–31 months). Results Postoperative and followup FAOS scores were similar in the three groups. The tibiofibular clear space was greater in the S versus the PM group, but we found no other differences in the postoperative versus followup measurements between the PM, S, and C groups. Conclusions Syndesmotic fixation through the posterior malleolus and PITFL is maintained at followup, and these patients have functional outcomes at least equivalent to outcomes for patients having syndesmotic screw fixation. Level of Evidence Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-009-1111-4