Syndesmosis Fixation Research Articles

Syndesmosis Fixation in Unstable Ankle Fractures Using a Partially Threaded 5.0-mm Cannulated Screw

The present study evaluated the radiographic outcomes of syndesmosis injuries treated with a partially threaded 5.0-mm cannulated screw. The present study included 58 consecutive patients with syndesmosis injuries concurrent with ankle fractures who had undergone operative fixation with a partially threaded 5.0-mm cannulated screw to repair the syndesmosis injury. Radiographic indexes, including the medial clear space, tibiofibular overlap, tibiofibular clear space, and fibular position on the lateral radiograph, were measured on the preoperative, immediate postoperative, and final follow-up radiographs. The measurements were compared between the injured and intact ankles. All preoperative radiographic indexes, including the medial clear space (p < .001), tibiofibular overlap (p < .001), tibiofibular clear space (p < .001), and fibular position on the lateral radiograph (p = .026), were significantly different between the injured and intact ankles. The medial clear space of the injured ankle was significantly wider than that of the intact ankle preoperatively (p < .001) and had become significantly narrower immediately postoperatively (p < .001). Finally, the medial clear space was not significantly different between the injured and intact ankles at the final follow-up examination (p = .522). No screw breakage or repeat fractures were observed. A 5.0-mm partially threaded cannulated screw effectively restored and maintained the normal relationship between the tibia and fibula within the ankle mortise with a low risk of complications. This appears to be an effective alternative technique to treat syndesmosis injuries concurrent with ankle fractures.

Medial Structure Injury During Suture Button Insertion Using the Center-Center Technique for Syndesmotic Stabilization.

The center-center technique for syndesmosis fixation has been described as an improved and reliable technique for proper reduction of the syndesmosis during ankle fracture repair. Concurrently, the use of flexible fixation with a suture button is becoming an established means of syndesmosis stabilization. The purpose of this cadaveric study was to assess for medial structure injury during the placement of a suture button using the center-center technique for ankle syndesmosis repair at 3 insertion intervals. Simulated open syndesmosis repair was performed on 10 cadaveric specimens. Three intervals were measured at 10 mm, 20 mm, and 30 mm proximal to the level of the distal tibial articular surface along the fibula. Proper longitudinal alignment of the center-center technique was completed under fluoroscopic guidance and was marked on the medial aspect of the tibia. The 3 intervals were drilled in the appropriate technique trajectory. The suture button was subsequently passed through each drill-hole interval. A single observer used a digital caliper to measure the distance from each suture button aperture with respect to the tibialis anterior tendon, tibialis posterior tendon, and greater saphenous vein and nerve. A total of 30 interval measurements (10 cadavers with 3 suture button segments each) were used for data analysis. Direct impingement on the greater saphenous vein was seen in 11 of 30 (36.6%) interval measurements. Six of the 11 (54.5%) observed saphenous structure impingement events occurred at the 10-mm drill hole. The results of the present study suggest that the use of the center-center technique for syndesmosis repair with suture button fixation risks preventable injury to the greater saphenous neurovasculature. To understand the medial ankle anatomy, as it pertains to insertion of flexible syndesmotic fixation in a cadaveric model, to aid in prevention of clinical iatrogenic injury.

Effect of Ankle Position on Tibiotalar Motion With Screw Fixation of the Distal Tibiofibular Syndesmosis in a Fracture Model.

Anatomic reduction and fixation of the syndesmosis in traumatic injuries is paramount in restoring function of the tibiotalar joint. While overcompression is a potential error, recent work has called into question whether ankle position during fixation really matters in this regard. Our study aimed to corroborate more recent findings using a fracture model that, to our knowledge, has not been previously tested. Twenty cadaver leg specimens were obtained and prepared. Each was tested for tibiotalar motion under various conditions: intact syndesmosis, intact syndesmosis with lag screw compression, pronation external rotation type 4 (PER-4) ankle fracture with syndesmotic disruption, and single-screw syndesmotic fixation followed by plate and screw fracture and syndesmotic screw fixation. In each situation, the ankle was held in alternating plantarflexion and dorsiflexion when inserting the syndesmotic screw with the subsequent amount of maximal dorsiflexion being recorded following hand-tight lag screw fixation. While ankle range of motion increased significantly with creation of the PER-4 injury, under no condition was there a statistically significant change in maximal dorsiflexion angle. Ankle position during distal tibiofibular syndesmosis fixation did not limit dorsiflexion of the ankle joint. Our findings suggest that maximal dorsiflexion during syndesmotic screw fixation may not be necessary.

Repair of syndesmosis injury in ankle fractures: Current state of the art.

Conventional treatment of syndesmosis injuries in rotationally unstable ankle fractures is associated with an unacceptably high rate of malreduction, and this has led to a paradigm shift in the approach to a newer concept of anatomical repair.In the anatomical approach, the principle is to ‘directly fix what is broken and repair what is torn’. The approach is effective in reducing the rate of syndesmosis malreduction, increasing the biomechanical strength of syndesmosis fixation and avoiding the need for trans-syndesmotic fixation and its secondary removal.The objective of this review article is to compare the conventional treatment of these injuries (accepted usage, general consent, traditional, generally accepted) with a newer anatomical approach to be considered as a shift in thinking.Cite this article: EFORT Open Rev 2018;3:24-29. DOI: 10.1302/2058-5241.3.170017

A new intraoperative classification of distal tibiofibular syndesmosis injury and internal fixation

Objective To investigate the guidance of a new intraoperative classification of distal tibiofibular syndesmosis injury in the selection of internal fixation for ankle fractures. Methods Between January 2010 and January 2015 our department treated 116 patients with displaced closed ankle fracture (Weber type B or C). They were 60 men and 56 women, aged from 18 to 78 years (average, 45.6 years). After reduction and fixation of the fibular fracture, we assessed the syndesmosis stability using the fibular hook traction test and radiological findings. We classified the distal tibiofibular syndesmosis injury into 3 grades (grade Ⅰ: 7 mm displacement). Se-lection of proper screwing was determined by our new classification. Results Of the 116 cases, 82 (70.7%) demonstrated distal tibiofibular syndesmosis injury. Screwing of the distal tibiofibular syndesmosis was not conducted for 30 (25.9%) of them who were of stable grade Ⅰ. 52 (44.8%) cases were of unstable grades Ⅱ and Ⅲ. Of the 48 cases of grade Ⅱ, 44 were fixated with one screw and the rest 4 became stable grade Ⅰ after Volkmann block fixation and received no screwing. Fixation of the distal tibiofibular syndesmosis with 2 screws was conducted for the 4 cases of unstable grade Ⅲ. All the patients were followed up for 12 to 60 months. No non-union, screw breakage, or syndesmosis separation after screw removal occurred. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring showed a good/excellent rate of 93.1% (108/116) . Conclusion Our new intraoperative classification can provide correct judgment of the severity of distal tibiofibular syndesmosis injury, thus guiding the selection of proper screw fixation to enhance the outcomes of ankle fractures. Key words: Ankle joint; Fractures, bone; Fracture fixation, internal; Distal tibiofibular syndesmosis; Classification

Strength of syndesmosis fixation: 2 TightRope versus 1 TightRope with plate-and-screw construction

Strength of syndesmosis fixation: 2 TightRope versus 1 TightRope with plate-and-screw construction

Cost analysis of ankle syndesmosis internal fixation

BackgroundUnstable ankle syndesmosis injuries are common, and the optimal surgical fixation is controversial. The two main options for stabilization of syndesmotic injuries are suture button fixation and screw fixation. Suture button fixation has a higher initial cost, but may have a lower hardware removal rate. The purpose of this study was to compare the costs of syndesmotic fixation. MethodsA cost analysis was performed at a single university-affiliated hospital. Variables included the number of suture buttons, the number and type of syndesmosis screws used, and the frequency of hardware removal and operative time required for hardware removal. There were four clinical scenarios evaluated: (A) one suture button versus one cortical screw; (B) two suture buttons versus two cortical screws; (C) one suture button versus one locking screw; (D) two suture buttons versus two locking screws. Suture button removal rate was assumed to be 0% in the analysis. ResultsCost equivalence was achieved at an 18 to 53% syndesmotic screw removal rate depending on the fixation construct used and the amount of time required for hardware removal. When the syndesmosis screws were removed 100% of the time, suture button fixation was more economical by $85,000–$194,656 per 100 ankles. When hardware was never removed, suture button fixation was more expensive by $169,844–$295,500 per 100 ankles. ConclusionThis study demonstrates that the costs associated with syndesmosis fixation are more dependent on the rate of hardware removal than the type of hardware utilized. Routine removal of syndesmosis screws is clearly less economical than suture button fixation.

Not Your Ordinary Ankle Sprain

HISTORY: This is a case of an otherwise healthy 19-year-old running back who sustained a left ankle eversion type injury during a football game when an opponent landed on his lower leg forcing it into external rotation. He did not finish playing due to the inability to bear weight. PHYSICAL EXAMINATION: During initial evaluation, limited due to a significant amount of pain, he had tenderness over the deltoid, anterior talofibular, and calcaneofibular ligaments. During reevaluation two days later he was also complaining of some tenderness around the lateral aspect of his left knee. His exam showed mild edema at the level of his ankle, tenderness over ligaments as noted before, along with pain on external rotation of his foot, compression along his syndesmosis, and palpation over his tibiofibular joint with increased posterior translation of his proximal fibula compared to the contralateral side. His left knee exam revealed pain in the area of his fibular head with varus stress, but was otherwise unremarkable. DIFFERENTIAL DIAGNOSIS: Ankle fracture Syndesmosis injury Proximal tibiofibular joint injury TEST AND RESULTS: Stress radiographs of left ankle at the stadium: - no acute fracture and no obvious opening of his syndesmosis or medial joint space Repeat weight bearing radiographs of left ankle: - ossification of his syndesmosis likely indicative of previous injury, as well as decreased overlap between distal tibia and fibula - no clear evidence of medial ankle joint space widening MRI of left calf and ankle: - no ligamentous tear of the proximal tibiofibular joint, but changes consistent with chronic avulsion injury of the syndesmotic membrane from the distal portion of the tibia and probable injuries to his anterior inferior tibiofibular ligament and anterior talofibular ligaments FINAL WORKING DIAGNOSIS: Syndesmosis injury with proximal tibiofibular joint instability TREATMENT AND OUTCOMES: 1. Non-weightbearing for the initial 10 days post injury. 2. Open reduction and internal fixation of distal syndesmosis using a single tightrope fixation, along with stabilization of the proximal tibiofibular joint using the same technique. 3. Non-weightbearing for the following 6 weeks. 4. Gradual return to physical activity.

Surgical Treatment of Ankle Syndesmosis Injuries with Syndesmosis Elastic Hook.

Surgical Treatment of Ankle Syndesmosis Injuries with Syndesmosis Elastic Hook.

The use of TightRope fixation for ankle syndesmosis injuries: our experience.

Ten percentage of all ankle fractures sustain an associated syndesmotic injury. TightRope is a relatively new technique for syndesmosis fixation, characterized by a non-absorbable FibreWire held tight between two cortical metal buttons. The purpose of this study was to evaluate the results obtained with the use of this device. From January 2011 to December 2015, 54 patients with ankle diastases were treated. Eighteen patients were excluded from the study. Fractures of the fibula or tibia requiring fixation were internally fixed using standard AO techniques. Preoperative and the most recent postoperative ankle radiographs were reassessed for measurements of the tibiofibular clear space (TFCS), medial clear space (MCS) and tibiofibular overlap (TFO). Clinical outcomes were assessed at the time of follow-up using the American Orthopaedic Foot and Ankle Society (AOFAS) score, a self-administered Foot and Ankle Disability Index (FADI) score and patients satisfaction. The mean follow-up was 28, 64months. Mean values for MCS, TFCS and TFO were 1.51-1.53 and 0.25cm, respectively. The mean AOFAS score was 93.11, and the mean FADI score was 130.11. Twenty-nine (80.6%) patients reported their outcome as excellent or very good. TightRope technique can achieve flexible fixation of the syndesmosis and permit full range of motion of the tibiofibular joint. Patients can start rehabilitation exercise at an early stage after operation. The results of this study indicate that TightRope fixation is a valid option for syndesmotic injuries.

Rigid Syndesmotic Fixation Alters Joint Contact Mechanics and Talar Kinematics

Category: Trauma Introduction/Purpose: The variety of methods available for performing syndesmotic fixation have led to significant controversy about the optimal method of surgical fixation, and the effects of syndesmotic fixation on the biomechanics of the ankle remain poorly understood. The purpose of the present study was to use a cadaveric model to evaluate the effects of progressively increasing syndesmotic fixation on talar motion and contact stress on the talar dome and in the medial and lateral gutters. Methods: Twelve fresh-frozen cadaveric specimens were dissected to expose the ankle joint while leaving ligaments, syndesmosis, and interosseus membrane intact, simulating a best-case fibular reduction. Rigid clusters of reflective markers were attached to the tibia, the distal fibula, and the talus for tracking with a motion capture system. A Tekscan pressure sensor was inserted into the tibiotalar joint (n=6) or into both gutters (n=6) for measuring contact stress. A 600N axial load was applied in a custom-built ankle simulator which permitted free internal/external rotation and inversion/eversion while holding either 20°plantar flexion, 10° plantar flexion, neutral, or 10° dorsiflexion. Specimens were tested without fixation, with one 3.5mm screw, and with two 3.5mm screws. Motion data were rotated into an anatomic reference frame and a fixed center of rotation (CoR) of the talus was calculated in the sagittal plane. Tekscan data were analyzed for changes in peak contact stress and changes in contact area. Results: Antero-posterior translation of the talus was variable with increasing fixation and specimen dependent. A single 3.5mm screw shifted the average CoR posteriorly 0.4 mm, and two 3.5mm screws shifted the average talar CoR anteriorly 1.6mm. Five specimens shifted posteriorly with fixation, while the other specimens moved anteriorly, resulting in extremely large standard deviations of AP movement. Peak contact stress on the talar dome decreased 10%-20% with the addition of syndesmotic fixation. Contact area on the talar dome decreased with increased syndesmotic fixation. Conversely, peak contact stress in the medial and lateral gutters increased with the addition of syndesmotic screws, although the magnitude was substantially lower than peak stresses in the talar dome. Contact areas in both gutters tended to increase with each syndesmotic screw. Conclusion: Fixation of the distal tibiofibular syndesmosis altered the biomechanical behavior of the ankle, generally shifting the talus slightly anteriorly, decreasing the load on the tibiotalar articulation, and increasing medial and lateral gutter contact stress. The specimen-to-specimen variability was noteworthy. While the variability lead to large standard deviations and prevented some mechanical trends from achieving statistical significance, it became very apparent that there are certain individuals who would suffer grossly abnormal ankle mechanics after rigid syndesmotic fixation, and a more aggressive fixation would amplify the mechanical abnormalities.

Analysis of Clinical Outcomes and Prognostic Factors in Bosworth Fractures

Category: Trauma Introduction/Purpose: Unlike routine ankle fractures, Bosworth fracture-dislocation lead to devastating complication such as compartment syndrome, neurovascular injury, and subsequent ankle OA more frequently. However, due to the low incidence of this injury, no study have reported clinical outcomes of Bosworth fracture in comparison to which of routine ankle fractures or these prognostic factors. Therefore this study was performed to assess and compare the outcomes of Bosworth fracture- dislocation to that of routine ankle fractures and understand the prognostic factors in order to prevent the irreversible and severe status. Methods: Twelve patients were followed for more than 1 years after surgical management for Bosworth fracture-dislocation. The mean age was 39.2 years, and the mean follow-up period was 38.4 months. All patients were treated with ORIF including syndesmosis fixation. The clinical evaluation consisted of the AOFAS ankle-hindfoot score, Olerud &amp; Molander scale. Reduction of tibiofibular syndesmosis and restoration of the ankle mortise were evaluated with plain radiographs and 3-D CT. The clinical and radiological outcomes were compared to those of routine ankle fractures (50 patients). To detect prognostic factors affecting the clinical results, age, fixation methods, interval to operation, existence of post. malleolar fractue, shape of fibular fracture, number of syndesmotic screw, frequency of closed reduction trial were studied. Results: Clinical results of Bosworth fracture-dislocation showed improvement including AOFAS score (87.6 on average) and Olerud and Molaner scale (89.7 on average), and corresponded to those results of routine ankle fracture (p = 0.234). All the patients achieved union in 12.6 weeks on average. However, postoperative CT revealed syndesmotic diastasis in 5 of 12 cases As complication, there were two cases of compartment syndrome, 2 cases of posttraumatic OA, 2 cases of ankle stiffness. Interval to operation and frequency of closed reduction trial were foud to be predictive factors of poor outcomes (p = 0.003, 0.011 respectively). Conclusion: The results of our study showed that although the clinical results were comparable statistically, Bosworth fracture are more frequently associated with the development of complications than routine ankle fractures. More specifically, prolonged interval between occurrence of fracture and surgical fixation and repeated attempts of closed reduction are at risk for poor outcomes. A prospective study with sufficient power would be needed to further identify risk factors associated with complications.

Technique Tip: Novel Use of a Targeting Drill Guide for Syndesmotic Screw Placement.

Ankle fractures are among the most common traumatic injuries encountered by orthopaedic surgeons, but obtaining anatomic syndesmosis fixation can be difficult. Previous authors have described the centroidal axis of the syndesmosis. Our group has developed a novel technique of aligning the tibia and fibula along their anatomic centroidal axis using a targeting guide, which has showed good results in 1 patient at 1-year follow-up. Level V: Expert opinion.

Revision Ankle Syndesmosis Fixation: Functional Outcome after TightRope® Fixation

ABSTRACT Introduction Syndesmotic injuries present a challenge to orthopedic surgeons. Malreduction of the syndesmosis has been reported to cause instability and secondary osteoarthritis and is correlated with poor subjective and objective outcomes. There are very few studies that report the outcome after revision fixation of these injuries. Previous studies have reported varying techniques for revision syndesmosis reconstruction, including screw fixation and tendon transfers. We present the results of the use of the TightRope® suture for revision syndesmosis fixation. This implant has the advantage of maintaining physiological motion whilst allowing for healing of syndesmotic ligaments and prevents the need for further surgery to remove screws in already scarred soft tissues. Materials and methods We retrospectively analyzed 124 patients who required syndesmotic stabilization from January 2000 until December 2009. Eight of these 124 patients required surgical revision of their failed syndesmosis fixation, each of which was stabilized with the TightRope® Suture. All eight patients were followed up and their outcomes assessed. Seven of the eight patients in our study had technically sound initial fixation of the syndesmosis. Four of the eight patients had syndesmotic separation after screw removal 10 weeks after primary fixation. Results In our study, 6 of the 8 patients had good or satisfactory outcomes based on American Orthopedic Foot and Ankle Society (AOFAS) scores. In spite of accurate revision fixation of the syndesmosis, two patients required further surgery. One patient had conversion to an ankle fusion because of persistent syndesmotic widening and ongoing pain after revision surgery. Another patient required syndesmotic arthrodesis as a result of persistent pain. Conclusion TightRope® suture fixation is a good method of syndesmosis stabilization in patients requiring revision surgery. Randomized studies would be required to compare the effectiveness of this method of fixation with screw fixation. How to cite this article Rajagopalan S, Moonot P, Sangar A, Taylor H. Revision Ankle Syndesmosis Fixation: Functional Outcome after TightRope® Fixation. J Foot Ankle Surg (Asia- Pacific) 2016;3(1):23-27.

Strength of Syndesmosis Fixation: Two TightRope versus One TightRope with Plate-and-Screw Construct.

Injuries involving the distal tibiofibular syndesmosis can lead to critical destabilization of the ankle mortise. Although specific indications for operative fixation remain unclear, accurate reduction of the syndesmosis has been correlated with the best functional outcomes. The purpose of this study was to evaluate the maximum torque and rotation to failure after fixation with a novel construct. Seven pairs (14 ankles) of embalmed cadaveric lower legs, disarticulated at the knee, were obtained. Each pair was randomly assigned to receive either two TightRopes (Arthrex) or a plate-and-screw construct with one TightRope. All samples were mechanically tested in torsion to determine peak torque, torsional stiffness, and the maximum rotation angle at which failure occurred. Differences between the groups were compared using paired Student's t test. The maximum torque to failure after fixation was not significantly different between the two TightRopes (28.8 N*m; range, 7.3-49.7 N*m) and the one TightRope group (29.5 N*m; range, 9.2-44.9 N*m; p = 0.92). The maximum rotation to fracture after fixation was not significantly different between the two TightRopes (33.3 degrees; range, 21.6-57.0 degrees) and one TightRope group (38.6 degrees; range, 23.0-73.9 degrees). All specimens failed with the fracture of the fibula at the level of the inferior syndesmotic screw. The similar load to failure of the two TightRope and the one TightRope and plate-and-screw plate suggested similar stiffness between the two constructs. The addition of the plate may improve distribution of forces at the level of syndesmosis, reducing stress risers and decreasing the risk of failure, as demonstrated by a lower rotation to failure of the one TightRope with plate-and-screw construct. In addition, this construct is not likely to not be associated with any substantial cost increase. Further clinical studies may further elucidate the role of plate and/or TightRope augmentation to syndesmosis fixation.

Modeling of tibia and fibula fixation with tensioned loops in cases of injuries of the tibiofibular syndesmosis

Malleoli fractures in case of the ankle joint (AJ) injuries accom­panied by injuries of ligamentous structures of the syndesmosis and subluxation of the foot. Promising method of treatment of the syndesmosis injuries is fixation with tensioned loop.Objec­tive: based on mathematical analysis and magnetic resonance imaging (MRI) data to justify rules of tensioned loop using in surgical treatment of suprasyndesmotic fractures of the lateral malleolus.Objectives: 1) to determine the optimal angle between two tensioned loops in a horizontal plane for fixation of the tibio­fibular syndesmosis totally damaged; 2) to substantiate the level of tensioned loops’ passage; 3) to identify anatomical landmarks for fixation of syndesmosis with tensioned loops.Methods: as a mathematical model we used a simplified scheme of loading in «tibia – fibula – tensioned loop» system. MRI was performed in 16 patients (7 women and 9 men, age 20–38 years) with no signs of bone structures damage and AJ syndesmosis. We carried out measurements at a distance of 4 and 2 cm above the AJ gap in axial projection.Results: it was found that the optimal angle be­tween a tensioned loop in the horizontal plane which ensures the stability of lateral malleolus fixation in fibular notch of the tibia in sagittal and frontal planes. For syndesmosis fixation tensioned loops should be placed to the articular tibial surface as close as possible. With help of MRI there was found that the maximal possible angle between two tensioned loops in a horizontal plane at 2 cm above the AJ space an average on 10° is higher than at 4 cm above the AJ space. Passing loops not exceeding 2 cm from the AJ plane will help to achieve the maximally possible angle between them and to provide stable fixation of the lateral malleo­lus in fibular notch of the tibia in sagittal and frontal planes.

Dilemmas in the choice of treatment of tibiofibular syndesmosis in malleolar fractures

Introduction. Ankle joint fractures are one of the most common injuries dealt with by orthopedic surgeons. Objective. To determine to what extent do diagnostics, estimation and choice of treatment of tibiofibular syndesmosis injuries affect the final clinical result. Patients and Methods. The study represents retrospective-prospective analysis of the data obtained from 102 patients treated for ankle injury due to malleolar ankle joint fractures and tibiofibular syndesmosis at the Clinic of Traumatology. The average value of monitoring was 61.62 months. According to the Danis-Weber classification, C1 fracture was present in 77 respondents (75.49%); C2 in 23 (22.5%); and C3 fracture in 2 respondents (1.96%). The Danis-Weber classification was used in this paper and hence we divided 102 patients with type C fractures according to the above mentioned classification. The first group (G1) was consisted of 48 (47%) patients who had undergone the syndesmotic screw fixation during the surgery treatment of fracture stabilization. The second group (G2) was consisted of 54 (53%) patients who did not require the syndesmotic screw fixation during the surgery treatment of fracture stabilization. The syndesmotic screw was placed in cases of: supra-syndesmotic fractures of the fibula associated with rupture of the deltoid ligament and fracture types according to the Topliss A and B. Three, six and twelve months after the surgery, the clinical results were examined using the American Orthopaedic Foot and Ankle Society scoring scale. Discussion. All acute unstable injuries should be treated surgically, which includes the deltoid ligament repair, open reduction and internal fixation of the injured syndesmosis. This is considered to be the best way to avoid unwanted complications. Conclusion. There was no significant difference in the final results of treatment between patients from the group G1, where the syndesmotic screw fixation was performed, and patients from the group G2, where the syndesmotic screw fixation was not performed.

Comparative Study of Tricortical versus Quadricortical Syndesmosis Fixation in Ankle Fractures

Objective: To assess short-term functional results in 2 types of syndesmotic fixation, comparing the traditional rigid quadricortical syndesmotic screw fixation with a more dynamic tricortical screw fixation. Method: PATIENTS: Thirty nine patients (Age group: 20 to 50 yr) with closed ankle fractures in which the syndesmosis was found to be unstable clinically, radiographic and confirmed intra operatively. INTERVENTION: The unstable syndesmoses were fixed with either one cortical screw through both tibial cortices (n = 18) QSF or two cortical screws engaging only 1 cortex of the tibia (n = 21) TSF. The quadricortical and the tricortical screws were removed only in the case of discomfort. However, all quadricortical screws were removed at 6 month follow up. Rehabilitation was the same in both groups. DESIGN: Prospective, randomized single blinded clinical study. SETTING: Department of orthopaedics and traumatology MGM Medical College & M Y Hospital Indore. And G.R. Medical College & Jayarogya Hospital, Gwalior. Results: At the end of three months mean OM score was 65.35 (55 to75) For TSF group as compared to59.58 (55 to65) in QSF group. Mean values were similar between the two groups with respect to pain, swelling, support, running and jumping. The overall difference noted in two groups was due to difference in Mean value for functional parameter like stair climbing, Squatting and activities of daily living. At six months there was no significant difference in any parameter of OM score. Hence the overall scores were with non-significant difference {TSF76.42 (70 To 80) and QSF72.42 (65 to 80). A three months DID was 12.07 (9to17) in TSF and 9.75 (6to13) in QSF with significant difference in two groups. At six months difference was non significant 4.75 for TSF and 4.42 for QSF Group. The one set of tricortical screws and two Quadricortical were removed in patients due to infection. Quadricortical group was re-operated in 3 (16.66 %) cases for screw removal in case of

Foot &amp; Ankle

The December 2014 Foot &amp; Ankle Roundup360 looks at: Charcot feet, biomarkers and diabetes; weight bearing following Achilles tendon rupture; endobuttons and mal-reduced diastasis; evidence for stem cell therapies in osteochondral lesions of the talus; syndesmosis fixation in SER ankle fractures; and self-reporting for foot and ankle outcomes.

Effect of syndesmosis injury in SER IV (Weber B)-type ankle fractures on function and incidence of osteoarthritis.

Syndesmosis fixation of Lauge-Hansen SER IV, Weber B ankle fractures is controversial. This study compared a matched pair of SER IV patients with stress proven syndesmotic injuries with the same number without stress proven syndesmotic injury in terms of functional, pain, and radiologic result. The study was based on a RCT-study comparing syndesmotic transfixation to no fixation in SER IV (Weber B)-type ankle fractures. Twenty-four patients with a syndesmosis injury found on the intraoperative 7.5 Nm standardized external rotation test were compared to 24 patients with a stable syndesmosis. The pairs were matched by fracture morphology, sex, and age. The primary outcome measure was ankle function as assessed by the Olerud-Molander score. Weight-bearing plain radiographs and 3T MRI of the injured ankle were used to assess ankle joint congruity and osteoarthritis, according to Kellgren-Lawrence classification and cartilage defects. The Olerud-Molander score was 86 in syndesmosis injury patients and 90 in patients with normal syndesmosis (P = .28). The incidence of ankle joint osteoarthritis on plain radiographs was not significantly different between the groups (Grade I 5% vs 21%; Grade II 86% vs 75%; Grade III 9% vs 4%; P = .34). MRI scans showed TC joint cartilage defects in 54% of the patients: 12 (56%) in the syndesmosis injury group vs 13 (54%) in the group without syndesmosis injury (P > .9). After 4 to 6 years of follow-up, clinical and radiologic outcome were not different in patients with syndesmosis injury compared to patients with stable syndesmosis in SER IV (Weber B)-type ankle fractures. Prognostic Level II, comparative study.