Abstract
Introduction: With no current “gold standard” fixation strategy for syndesmotic injuries and differences in preferred preoperative and intraoperative diagnostic techniques and criteria, methods of reduction, fixation constructs, and postoperative management, the goals of this study were to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption, as well as to identify surgeon demographics predictive of syndesmotic management techniques.Methods: This study was conducted as a web-based survey of foot and ankle fellowship-trained surgeons, Orthopaedic Trauma Association (OTA) members, and Canadian Orthopaedic Association (COA) members. The survey, sent and completed via the HIPAA-compliant Research Electronic Data Capture (REDCap) system, consisted of 18 questions: 6 surgeon demographic questions and 12 specific syndesmotic management questions regarding perioperative protocols and syndesmotic fixation construct techniques.Results: One hundred and ten orthopaedic surgeons completed our survey. Years of practice and type of fellowship were found to be the variables that influenced perioperative syndesmotic management strategies the most, while a number of fractures operated on per year, country of practice, and practice setting also influenced management decisions. Additionally, 59% (65/110) surgeons indicated that the way they have managed syndesmotic injuries has changed at some point in their career, while 33% (36/110) specified that they could foresee themselves changing their management of these injuries in the future.Conclusions: There was significant variability among responders in preoperative and intraoperative assessment technique, fixation construct, screw removal protocol, and postoperative weightbearing protocol. This study raises awareness of differences in and factors predictive of management strategies and should be used for further discussion when determining a potential gold standard for the management of these complex injuries.
Highlights
With no current “gold standard” fixation strategy for syndesmotic injuries and differences in preferred preoperative and intraoperative diagnostic techniques and criteria, methods of reduction, fixation constructs, and postoperative management, the goals of this study were to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption, as well as to identify surgeon demographics predictive of syndesmotic management techniques
A national database analysis recently reported an increase in syndesmotic fixation with ankle fracture open reduction internal fixation (ORIF), suggesting a surge in surgeon recognition which leads to more operative treatment of these often subtle injuries [5]
The survey was transferred to the Research Electronic Data Capture (REDCap) system [10], and a public link to the survey was given to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle fellowship-trained surgeons. We considered this cohort of surgeons to be the most experienced in treating syndesmotic injuries, with an eye towards including a diverse population of orthopaedic surgeons
Summary
With no current “gold standard” fixation strategy for syndesmotic injuries and differences in preferred preoperative and intraoperative diagnostic techniques and criteria, methods of reduction, fixation constructs, and postoperative management, the goals of this study were to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption, as well as to identify surgeon demographics predictive of syndesmotic management techniques. A national database analysis recently reported an increase in syndesmotic fixation with ankle fracture open reduction internal fixation (ORIF), suggesting a surge in surgeon recognition which leads to more operative treatment of these often subtle injuries [5]. Increasing emphasis in recent years has been placed on determining the optimal repair technique for unstable syndesmosis injuries, with good outcomes described using several different techniques [8,9]. The primary goal of treatment of ankle injuries with disruptions of the syndesmosis is to restore ankle joint alignment and stability [4,8], techniques currently vary in number, size, orientation, location, and types of devices implemented, as well as intraoperative and postoperative protocols [3,8]
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