Authors:
Mohammed
R, Syed S, Metikala S, and Ali SA
Journal: Indian Journal of Orthopedics
Abstract: Background:
With the length of the fibula restored and the syndesmosis reduced
anatomically, internal fixation using a plating device may not be necessary for
supra-syndesmotic fibular fractures combined with diastasis of inferior
tibio-fibular joint. A retrospective observational study was performed in
patients who had this injury pattern treated with syndesmosis-only fixation.
Materials and Methods: 12 patients who had
Weber type-C injury pattern were treated with syndesmosis only fixation. The
treatment plan was followed only if the fibular length could be restored and if
the syndesmosis could be anatomically reduced. Through a percutaneous or
mini-open reduction and clamp stabilization of the syndesmosis, all but one
patient had a single tricortical screw fixation across the syndesmosis.
Patients were kept non-weight-bearing for 6 weeks, followed by screw removal at
an average of 8 weeks. Outcomes were assessed using an objective ankle scoring
system (Olerud and Molander scale) and by radiographic assessment of the ankle
mortise.
Results: At a mean follow-up of 13 months, the
functional outcome score was 75. Excellent to good outcomes were noted in 83%
of the patients. Ankle mortise was reduced in all cases, and all but one
fibular fracture united without loss of fixation. Six patients had more than
one malleolar injury, needing either screw or anchor fixations. One patient had
late diastasis after removal of the syndesmotic screw and underwent revision
surgery with bone grafting of the fibula. This was probably due to early screw
removal, before union of the fibular fracture had occurred.
Conclusion: We recommend syndesmosis-only fixation as an
effective treatment option for a combination of syndesmosis disruption and
Weber type-C lateral malleolar fractures.
Keywords: Weber type-C ankle fractures, syndesmotic
disruption, syndesmosis-only fixation, functional outcomes
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