Syndesmotic Fixation in Supination-External Rotation Ankle Fractures: A Prospective Randomized Study
- 1 December 2011
- journal article
- research article
- Published by SAGE Publications in Foot & Ankle International
- Vol. 32 (12), 1103-1109
- https://doi.org/10.3113/fai.2011.1103
Abstract
Background: This study was designed to assess whether transfixion of an unstable syndesmosis is necessary in supination-external rotation (Lauge-Hansen SE/Weber B)-type ankle fractures. Methods: A prospective study of 140 patients with unilateral Lauge-Hansen supination-external rotation type 4 ankle fractures was done. After bony fixation, the 7.5-Nm standardized external rotation (ER) stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. If the stress test was positive, the patient was randomized to either syndesmotic transfixion with 3.5-mm tricortical screws or no syndesmotic fixation. Clinical outcome was assessed using the Olerud-Molander scoring system, RAND 36-Item Health Survey, and Visual Analogue Scale (VAS) to measure pain and function after a minimum 1-year of followup. Results: Twenty four (17%) of 140 patients had positive standardized 7.5-Nm ER stress tests after malleolar fixation. The stress view was positive three times on tibiotalar clear space, seven on tibiofibular clear space, and 14 times on both tibiotalar and tibiofibular clear spaces. There was no significant difference between the two randomization groups with regards to Olerud-Molander functional score, VAS scale measuring pain and function, or RAND 36-Item Health Survey pain or physical function at 1 year. Conclusion: Relevant syndesmotic injuries are rare in supination-external rotation ankle fractures, and syndesmotic transfixion with a screw did not influence the functional outcome or pain after the 1-year followup compared with no fixation. Level of Evidence: II, Prospective Comparative StudyKeywords
This publication has 25 references indexed in Scilit:
- Comparison of Two Intraoperative Assessment Methods for Injuries to the Ankle SyndesmosisThe Journal of Bone & Joint Surgery, 2009
- Computed tomography of normal distal tibiofibular syndesmosisSkeletal Radiology, 2009
- The Influence of the Number of Cortices of Screw Purchase and Ankle Position in Weber C Ankle Fracture FixationJournal of Orthopaedic Trauma, 2008
- Instability of the tibio-fibular syndesmosis: have we been pulling in the wrong direction?Injury, 2004
- External rotation stress imaging in syndesmotic injuries of the ankle: Comparison of lateral radiography and radiostereometry in a cadaveric modelActa Orthopaedica, 2003
- Disruption of the ankle syndesmosis: Biomechanical study of the ligamentous restraintsArthroscopy: The Journal of Arthroscopic & Related Surgery, 1994
- Syndesmotic ankle sprainsThe American Journal of Sports Medicine, 1991
- Syndesmosis Sprains of the AnkleFoot & Ankle, 1990
- A scoring scale for symptom evaluation after ankle fractureArchives of orthopaedic and trauma surgery, 1984
- Manual of Internal FixationPublished by Springer Science and Business Media LLC ,1979