Abstract
This clinical retrospective study explored factors associated with distal tibiofibular syndesmosis ossification (TFSO) after ankle fracture fixation. Between August 2012 and January 2015, 172 patients with ankle fractures (121 men) with an average age of 46.6 years (range, 22–71 years) were treated surgically with an average follow-up period of 26 months (range, 16–34 months). According to the Danis-Weber AO classification rubric, 54 fractures were type A, 78 were type B, and 40 were type C. According to the Lauge-Hansen classification, there were 17 supination-adduction (SA) fractures, 98 supination-external rotation (SE) fractures, 31 pronation-external rotation (PE) fractures, and 26 pronation-abduction (PA) fractures. The average injury to operation interval was 4.3 days (6 hours-7 days). Multiple factor analysis was conducted to examine risk factors for TFSO. It was observed in 36 (20.9%) cases (11 complete ossification cases; 25 partial ossification cases). Multivariate logistic regression revealed the following independent risk factors for TFSO were: AO classification, distal tibiofibular syndesmosis separation, and fibular fracture morphology. In conclusion, AO type C fracture, syndesmosis separation, and high fibular fracture were associated with distal TFSO following ankle fracture fixation.
Highlights
Ankle fracture is a common clinical finding, with recent epidemiological data showing occurrence rates of 120– 150/100,0001–4
Research showed that calcification of the anterior inferior tibiofibular ligament after distal tibiofibular syndesmosis sprain was the main cause of ossification[13]
Some recent case reports have suggested that tibiofibular syndesmosis separation and screw fixation are independent risk factors for postoperative synostosis[12,14,15]
Summary
The sample was comprised of 172 patients (121 men, 51 women) who were treated for ankle fracture, with a mean age of 46.6 years (range, 22–71 years); 74 (43%) patients were >50 years old. Treatment modalities include anatomical reduction and strong fixation of the ankle fracture and inferior tibiofibular syndesmosis. In a retrospective analysis of ankle fractures with inferior tibiofibular injury, Kaye[22] found an inferior tibiofibular osseous connection in 4/30 cases and ossification within the interosseous membrane in 3/40 cases. TFSO developed in the area of the fibular fracture line in 22 cases and around internally fixed screws in 14 cases. In addition to the adjacency of a fracture to the syndesmosis being a factor in local vascular injury, hematoma, and subsequent heterotopic ossification, surgical procedures (e.g., drilling) in this area can produce bone debris that leads to ossification. Hinds et al.[12] reported that male sex, ankle joint dislocation, and the use of screws in the inferior tibiofibular syndesmosis were the main reasons for ossification. Variable Sex Age group (years) Body mass index
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