Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury

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

Functional Outcomes after Fibula Locking Nail for Fragility Fractures of the Ankle

Authors: Aysha Rajeev, Shanaka Senevirathna, Sarkhell Radha, and N.S. Kashayap

Journal: JFAS Functional Outcomes after Fibula Locking Nail

Abstract:  The aim of the present study was to assess the functional outcome of fragility fractures of the ankle treated with a fibular locking nail. A retrospective review of 24 patients with fragility fractures treated with a fibular locking nail from January 2005 to December 2007 was performed. The fibular nail used in our study was Biomet SST (stainless steel taper) small bone locking nail for the fibula. The Olerud and Molander scale was used to assess the functional outcome at the end of 1 year. The domains of the Olerud and Molander scale are pain, stiffness, swelling, stair climbing, running, jumping, squatting, support, and the activities of daily living. The patients were interviewed by telephone or the questionnaire was send by mail. Of the 24 patients, 2 were men and 22 were women. The left side was affected in 15 patients. The age group ranged from 71 to 91 years (average, 79). Of the fractures, 10 were lateral alveolus, 8 were bimalleolar, and 6 were trimalleolar fractures. All the patients were followed up at 6 weeks, 12 weeks, and after 6 months. The average period to fracture union was 8.7 weeks. No wound breakdown or any deep infections developed. The average Olerud and Molander scale score was 57 (range 30 to 65). The use of fibular locking nails to treat these difficult fracture are quite crucial to achieve early mobilization and also to maintain a good fracture position. In our study, the use of fibular nails was a very useful and successful method of treating fragility fractures with a very low risk of 

complications. It also helps to restore function and results in patient satisfaction.

Keywords: Functional outcome, internal fixation, surgery, trauma

The Taylor Spatial Frame for Correction of Neglected Fracture Dislocation of the Ankle

Authors: Ravikiran Shenoy, George Kubicek, Michael Pearse

Journal:  JFAS Taylor Spatial Frame

Treatment of neglected fracture dislocations of the ankle poses a surgical challenge. Extensive open reduction can frequently be contraindicated because of local skin conditions and contractures. The Taylor Spatial Frame™ (TSF) has been used to reduce and maintain reduction of complex fractures. Its use in fracture dislocation of the ankle joint has not been described. We describe a case where a TSF was used to reduce and treat a 6-week-old fracture dislocation of the ankle. The TSF is a versatile device, which has a role in the management of both acute and neglected fractures.

Keywords: Ankle fracture, dislocation, neglected fracture dislocation, Taylor Spatial Frame

Hardware Related Pain and Hardware Removal after Open Reduction and Internal Fixation of Ankle Fractures

Johan H. Pot, Remco J.A. van Wensen, Jan G. Olsman 

The Foot and Ankle Online Journal 4 (5): 1 May 2011

Fractures of the distal tibia and fibula are one of the most common types of fractures in adults. [1] Whereas stable and non or minimally displaced fractures can be treated with cast immobilization, unstable dislocated ankle fractures require open reduction and internal fixation (ORIF) with plate and screws.

Long term functional outcome is satisfying in most patients, but a number of patients have persistent ‘hardware related’ complaints and tenderness that ‘require’ elective hardware removal. Aside from painful hardware, some asymptomatic patients also want their hardware removed for other reasons. Although hardware removal is frequently undertaken, it is not without risk and the results are often unpredictable. [2]

The more commonly reported risks of hardware removal are iatrogenic (nerve) injury, infections, delay in wound healing and re-fractures. In addition to medical considerations there is also an economic impact such as physician costs, hospital fees, patient loss of work and productivity. [2] Reports in literature are not consistent concerning the incidence of painful hardware and the outcome and pain relief after hardware removal. [3-5] This study was designed to document the incidence of late pain after ORIF of ankle fractures and to analyse the outcome, expectations and complications after hardware removal.

Key words: Ankle, Ankle Fracture, FAOS, Hardware, ORIF Ankle

See all of your internal and external fixation options for Ankle Fracture, Fibular Fracture, Medial Malleolar Fracture, and Pilon Fracture. 

Outcomes of Suture Button Repair of the Distal Tibiofibular Syndesmosis

Henry DeGroot, MD, FAAOS; Ali A. Al-Omari, MD; Sherif Ahmed El Ghazaly, MD, FRCS, PhD

Foot & Ankle International: March 2011 (Vol.32 #3) March 1, 2011 

Background: Recently, a suture button device has been advocated as a simple and effective method of repairing the syndesmosis. Proponents of the device have cited earlier weightbearing and elimination of the need for device removal as potential advantages over metallic screws. However, the available reports generally have short followup. With longer followup, some concerns about the suture button device have surfaced. Materials and Methods: We reviewed the clinical and radiographic results of 24 patients with acute injuries to the distal tibiofibular syndesmosis who were treated with suture button fixation. Average followup was 20 months. The primary outcomes measure was the AOFAS ankle hindfoot score. Secondary outcomes measures included a calibrated measurement of the tibiofibular clear space and tibiofibular overlap. Results: The average AOFAS score was 94 points. Syndesmotic parameters returned to normal after surgery and remained normal throughout the followup period. One in four patients required removal of the suture endobutton device due to local irritation or lack of motion. Osteolysis of the bone and subsidence of the device into the bone was observed in four patients. Three patients developed heterotopic ossification within the syndesmotic ligament, one mild, one moderate, and one who had a nearly complete syndesmotic fusion. Conclusion: The suture button device is an effective way to repair the syndesmosis. In our series, the reduction of the syndesmosis was maintained throughout the followup period. However, reoperation for device removal was more common than anticipated. Osteolysis of the bone near the implant and subsidence of the device may occur. 

Level of Evidence: IV, Intervention Case Series

Key Words: Ankle; Syndesmosis; Surgical Treatment