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

2015 ◽  
Vol 62 (1) ◽  
pp. 33-37
Author(s):  
Predrag Grubor ◽  
Fuad Dzankovic ◽  
Milan Mitkovic ◽  
Luigi Meccariello
Keyword(s):  
Ankle Joint ◽  
Screw Fixation ◽  
Deltoid Ligament ◽  
Tibiofibular Syndesmosis ◽  
Fracture Stabilization ◽  
Syndesmotic Screw ◽  
Significant Difference ◽  
Choice Of Treatment ◽  
Joint Fractures ◽  
Ankle Joint 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.

Does routinely repairing deltoid ligament injuries in type B ankle joint fractures influence long term outcomes?

Injury ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 2312-2317 ◽  
Author(s):  
Xu Sun ◽  
Ting Li ◽  
Zhijian Sun ◽  
Yuneng Li ◽  
Minghui Yang ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Deltoid Ligament ◽  
Type B ◽  
Long Term Outcomes ◽  
Ligament Injuries ◽  
Joint Fractures ◽  
Ankle Joint Fractures

scholarly journals Effect of Deltoid Ligament Repair versus Syndesmosis Fixation on Ankle Joint Stability After Bimalleolar Equivalent Ankle Fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008 ◽  
Author(s):  
Pablo Mococain ◽  
Richard Glisson ◽  
Diana Lorena Bejarano-Pineda ◽  
James Nunley ◽  
Mark Easley
Keyword(s):  
Ankle Joint ◽  
Ankle Fracture ◽  
Axial Load ◽  
Screw Fixation ◽  
External Rotation ◽  
Lateral Malleolus ◽  
Deltoid Ligament ◽  
Joint Stability ◽  
Ligament Repair ◽  
Syndesmotic Screw

Category: Trauma Introduction/Purpose: The current standard for stabilization of the talus within the ankle mortise after bimalleolar equivalent ankle fracture is open reduction and internal fixation (ORIF) of the lateral malleolus followed by syndesmotic screw fixation of the syndesmosis. Syndesmotic fixation may be associated with complications such as mal-reduction, joint stiffness, altered ankle biomechanics, and potential additional surgery for hardware removal. Consequently, some surgeons advocate ORIF of the lateral malleolus in conjunction with deltoid ligament repair rather than syndesmosis fixation. To our knowledge, clinical reports of this treatment option lack biomechanical evidence to support this approach. The purpose of this investigation was to compare ankle joint stability and contact pressures in a bimalleolar equivalent ankle fracture model treated with trans-syndesmotic screw fixation versus deltoid ligament repair. Methods: We prepared and tested seven fresh frozen cadaveric whole lower leg specimens with an undisturbed proximal tibiofibular joint. We tested each leg was tested under five conditions: (1) intact, (2) syndesmosis disrupted and deltoid ligament sectioned, (3) syndesmosis reduced w/ screw fixation, (4) deltoid repaired, and (5) both syndesmosis and deltoid ligament repaired. Under a nominal axial load, we applied controlled anterior, posterior, lateral, and medial drawer stresses to the foot using a custom-built testing apparatus and documented the resulting talar translation relative to the tibia. We also applied controlled internal and external rotation stresses to the ankle model and measured the provoked ankle joint rotations. In each condition, we measured peak ankle contact pressure (PACP) using a Tekscan pressure sensor under a physiologic axial load simulating single-limb stance. Results: Concurrent disruption of the syndesmosis and the deltoid ligament significantly (p<.05) increased anterior drawer, lateral drawer, and internal and external rotation. Subsequent deltoid repair significantly reduced anterior displacement to normal levels, but syndesmosis fixation did not. Lateral drawer was not significantly corrected until both deltoid ligament and syndesmosis were repaired. Deltoid repair and syndesmosis fixation each reduced internal rotation significantly, with further reduction to normal levels when both were repaired. External rotation remained elevated relative to the intact condition regardless of which structures were repaired. Deltoid repair and syndesmosis fixation achieved similar levels of posterior, lateral and medial drawer reduction, but these measures did not approach normal values until both were repaired. No significant differences in PACP were identified among the five tested conditions. Conclusion: Isolated repair of the deltoid ligament after a bimalleolar equivalent ankle fracture achieves markedly better anterior displacement stability than does fixation of the syndesmosis with a screw. Under the described testing conditions, the two procedures offer similar posterior, medial, and lateral talar displacement stability and similar levels of internal and external rotational stability. Given the complications that may be associated with rigid syndesmotic screw fixation, our investigation suggests that deltoid repair may represent a reasonable alternative to syndesmosis fixation.

scholarly journals ANKLE-JOINT FRACTURES.

The Lancet ◽  
1921 ◽  
Vol 198 (5121) ◽  
pp. 875
Author(s):  
Frank Romer
Keyword(s):  
Ankle Joint ◽  
Joint Fractures ◽  
Ankle Joint Fractures

Stable ankle joint fractures. Indications for operative or conservative treatment?

1999 ◽  
Vol 28 (6) ◽  
pp. 493-499 ◽  
Author(s):  
J. Richter ◽  
W. Schulze ◽  
G. Muhr
Keyword(s):  
Conservative Treatment ◽  
Ankle Joint ◽  
Joint Fractures ◽  
Ankle Joint Fractures

scholarly journals A Prospective, Randomized Investigation of Syndesmosis Injury Fixation

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0000
Author(s):  
Eric Giza ◽  
Todd Oliver ◽  
Patrick S. Barousse ◽  
Tyler Allen ◽  
Trevor Shelton ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Screw Fixation ◽  
Syndesmotic Injury ◽  
Short Term ◽  
Suture Button ◽  
Syndesmotic Screw ◽  
Fixation Group ◽  
Significant Difference ◽  
Vas Scores

Category: Ankle; Trauma Introduction/Purpose: Syndesmotic disruption occurs in 10 to 13% of all ankle fractures. It is present in 15 cases per 100,000 of the general population. There has been debate on the best treatment for syndesmotic injuries. The typical surgical treatments include fixation with either screws or suture button devices. The purpose of this study is to compare clinical outcomes of syndesmotic injuries treated surgically with either screws or suture button devices. It was hypothesized that suture button fixation would provide equal clinical results with less need for hardware removal. Methods: This was a multi-center, randomized, prospective clinical trial comparing two surgical interventions for treatment of acute syndesmotic injury. Subjects were placed into either screw fixation or the Suture-button device group. Subjects with clinical signs or radiographic evidence of syndesmotic injury were asked to participate in this study. Inclusion criteria was ages 18 to 65 years old with confirmed syndesmotic instability. The primary outcomes of the study were VAS scores (activity, pain, satisfaction) and FFI scores (pain, disability, activity) which were collected at preoperative state, 6 weeks, and 12 months postoperatively. Results: Sixty-five subjects were enrolled in this study. Thirty-two subjects received Suture-button fixation (49%) and 33 received screw fixation (51%). VAS scores and FFI scores for subjects treated with the Suture-button device or screw fixation comparing preoperative, six-week, and 12-month scores all showed clinical improvement. There was no significant difference between the two treatment groups (p >0.05).Nine subjects (27%) in the syndesmotic screw fixation group experienced adverse events, and only one subject (3%) in the suture-button group had adverse event. Conclusion: The short-term clinical outcomes suggest that both syndesmotic screws and suture-button devices are effective treatment options to address acute syndesmotic injuries. In the short-term (12-months), suture-button fixation resulted in significantly less adverse events compared to syndesmotic screw fixation group.

scholarly journals The outcome of a single percutaneous cannulated screw fixation in posterior malleolus fracture accompanied by medial or lateral malleolus fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0037
Author(s):  
Yoo Jung Park ◽  
Yougun Won
Keyword(s):  
Range Of Motion ◽  
Ankle Joint ◽  
Screw Fixation ◽  
Cannulated Screw ◽  
Medial Malleolus ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Category: Trauma Introduction/Purpose: Posterior malleolus fractures occur most commonly in the setting of a rotational ankle fracture. In the treatment of posterior malleolus fractures, the indications for the surgical procedure are determined by the size of the fragment and the articular congruity of the tibiotalar joint. In general, the size of the bone fragment is known to be an indication of surgery if it involves more than 25% of the joint surface, and if it is less than that, anatomical reduction and fixation of only lateral or medial malleolus was suggested. We evaluate the clinical and radiological results of fixation and early range of motion exercise using a single cannulated screw when the fragment of the posterior malleolus fracture is less than 25%. Methods: Among 60 patients with SER stage 3 or 4 who had undergone surgery from March 2010 to March 2014, percutaneous cannulated screw fixation was performed for posterior malleolus in 30 cases (Group 1). In the other 30 cases (Group 2), we did not perform the fixation for posterior malleolus fracture and only cast immobilization was done after fixation for lateral or medial malleolus. Mean follow-up period was 14.8 weeks(12~18) for the Group 1, 12.9 weeks(12~18) for Group 2. Mean age of patients was 46.6(19~78) for Group 1, 50.2(19~74) for Group 2. The range of motion was checked at week 2, 4, 12, and at last follow-up. Results: There was no significant difference of time to union and union rate between two groups, and AOFAS score between two groups also showed no significant difference(91.94(83~100) vs 90.8(85~100), p = 0.45). The range of motion of ankle joint at the final follow-up showed significant difference (Ankle ROM 52.7’ (45’~65’) vs 45.3’(35’~65’), (p<0.01) and complications between two groups also showed no significant difference. Conclusion: A single percutaneous cannulated screw fixation in posterior malleolus fracture accompanied by medial or lateral malleolus fracture can be performed in fractures with small fragment size and minimal displacement. We found that it can be a effective method to achieve early and wide range of motion of ankle joint after posterior mallolus fracture.

Experimental Ankle-Joint Fractures

1965 ◽  
Vol 36 (4) ◽  
pp. 408-417 ◽  
Author(s):  
Carl Hirsch ◽  
Jack Lewis
Keyword(s):  
Ankle Joint ◽  
Joint Fractures ◽  
Ankle Joint Fractures
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