Functional results of dynamic fixation for ankle syndesmotic injuries

Abstract

Background Syndesmotic injuries associated with ankle fractures don’t render uniform results despite good ‎reduction and stable internal fixation. An optimal method of fixation needs to be standardized for this type of injuries, resulting in improved ankle function. The aim of this study is to compare the functional and radiological results of TightRope syndesmotic fixation with the traditional screw fixation following syndesmotic ankle injuries. Patients and methods Eighty-four patients were included in this prospective study; they were divided into two groups: in the first group, one TightRope was used for syndesmotic fixation, whereas one screw was used in the second group. Clinical evaluation included the American Orthopedic Foot and Ankle Score (AOFAS) score, return to work, and pain and patient satisfaction. Radiological evaluation included both anteroposterior (AP) and lateral views with evaluation of the fixation device, alignment of the ankle, and reduction of syndesmosis. Results Of the 42 patients in each group, seven patients from group 1 and one from group 2 were absent at the completion follow up of the ‎rest of the cases. The mean AOFAS hindfoot–ankle score at the final follow-up was 91.7±8.7 (range: 72–100) in group 1 and 89.5±7.1 (range: 66–100) in group 2. The mean initial weight-bearing radiographic measurements for the tibiofibular clear space, tibiofibular overlap, and medial clear space (6 weeks postoperatively) were 3.7±0.5, 6.7±1.5, and 3±0.34, respectively, in group 1 and 3.7±0.5, 6.8±0.8, and 3.1±0.6 in group 2. The final weight-bearing radiographic measurements for the tibiofibular clear space, tibiofibular overlap, and medial clear space were 3.8±0.5, 6.3±1.3, and 3.1±0.3, respectively, in group 1 and 3.9±0.5, 6.2±0.8, and 3.3±0.5 in group 2. Conclusion TightRope is a reliable option for stabilization of ankle syndesmotic injuries and it may offer a method that is as effective as traditional Arbeitsgemeinschaft Osteosynthesefragen (AO) screw fixation, with the avoidance of the need for another surgery for implant removal.