Fixation of Posterior Malleolar Fractures Provides Greater Syndesmotic Stability
- 1 June 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics & Related Research
- Vol. 447, 165-171
- https://doi.org/10.1097/01.blo.0000203489.21206.a9
Abstract
Syndesmotic injuries are common in ankle fractures. Traditional syndesmosis fixation may be associated with a secondary procedure. When the posterior malleolus is fractured, the posterior syndesmotic ligaments may remain intact and attached to the fragment. Our goals were to establish the incidence of syndesmotic ligament ruptures in pronation-external rotation type ankle injuries associated with posterior malleolar fractures, and to assess syndesmotic stability after fixation of the posterior malleolus compared with using a syndesmotic screw. Fifteen patients who sustained pronation-external rotation Stage 4 ankle fractures that involved the posterior malleolus were evaluated using radiographs and magnetic resonance imaging. No complete tears of the posterior-inferior tibiofibular ligament occurred. A pronation-external rotation fracture pattern with a posterior malleolar fragment was created in 10 lower extremity cadaver specimens with random fixation of the posterior malleolus or the syndesmosis. Compared with the intact specimens, stiffness was restored to 70% after fixation of the posterior malleolus, and to 40% after syndesmosis stabilization. Syndesmotic stability may be obtained more effectively by fixation of the posterior malleolus rather than by using a syndesmotic screw. Although additional clinical investigation is warranted, these concepts may be useful in eliminating syndesmotic screw fixation in select patients.Keywords
This publication has 56 references indexed in Scilit:
- Operative Treatment of Syndesmotic Disruptions Without Use of a Syndesmotic Screw: A Prospective Clinical StudyFoot & Ankle International, 1994
- Ankle Fracture Classification Systems: A Case for Integration of the Lauge-Hansen and AO-Danis-Weber SchemesFoot & Ankle, 1992
- Controversies in Diagnosis and Management of Syndesmosis Injuries of the AnkleFoot & Ankle, 1992
- Repair of the Tibiofibular Syndesmosis with a Flexible ImplantJournal of Orthopaedic Trauma, 1991
- Ankle Mortise Stability in Weber C FracturesJournal of Orthopaedic Trauma, 1991
- Fractures of the Posterior Tibial MarginJournal Of Trauma-Injury Infection and Critical Care, 1989
- Effect of the Syndesmotic Screw on Ankle MotionFoot & Ankle, 1989
- Stabilization of Ankle Syndesmosis Injuries With a Syndesmosis ScrewFoot & Ankle, 1989
- Stability of the loaded ankleThe American Journal of Sports Medicine, 1985
- The Role of Soft Tissues in the Stabilization of Tibial FracturesPublished by Ovid Technologies (Wolters Kluwer Health) ,1974