Post-treatment functional outcomes of distal tibiofibular syndesmosis injuries with varying duration and method of stabilization

Abstract

The purpose of this study was to assess whether the type and duration of screw fixation affects ankle joint functional scores and patient activity levels. We evaluated 55 patients who had undergone surgical treatment for ankle fracture with concomitant distal tibiofibular syndesmosis injury. The follow-up period ranged from 2 years to 4 years and 2 months (mean 36 months). Depending on the time of screw removal, patients were divided into two groups (the 8-15-week group - 19 patients, and the 16-22-week group - 36 patients). There were 17 patients with tricortical and 38 patients with quadricortical syndesmosis fixation. The following parameters were assessed: range of motion, rates of complications, level of pain in visual analogue scale (VAS), and function. In the quadricortical fixation group the range of plantar flexion p=0.04 and adduction p=0.043 were significantly lower in the operated than in the non-operated limb. In the patients who had their syndesmotic screws removed after 16-22 weeks, the range of plantar flexion in the operated limb was significantly lower than that in the non-operated limb. We observed no differences between the evaluated groups in terms of ankle joint mobility, VAS pain levels, functional outcomes, or complication rates. All the analyzed subgroups showed poorer ranges of some types of motion in the ankle and worse functional scale and VAS pain scores after treatment in comparison with those before the injury. We suggest removing the syndesmotic screws after 8-15 weeks, due to the possibility of earlier rehabilitation, faster return to work and physical activity and less burden on the health care system. Tricortical or quadricortical syndesmosis fixation is at the surgeon's discretion. LEVEL OF CLINICAL EVIDENCE: Level 3, Case-control study.