Syndesmotic screw fixation in tibiofibular diastasis

Abstract

Background: In chronic instability of syndesmosis, osteoarthritis and poor functional outcome were seen more prevalently. To avoid diastasis of ankle joint, the affected distal tibiofibular syndesmosis should be restored. We evaluated the clinical and radiological results of operative treatment of ankle fractures in patients who required syndesmotic stabilization.

Materials and Methods: Twenty‑one patients operated for ankle fracture were evaluated. Patients were followed up for 12 to 81 months, with a mean value of 49 months. Anteroposterior (AP), lateral, and mortise radiographs were taken at the follow‑up period, and AP tibiofibular distance, lateral fibular distance, and medial mortise distance were measured on the preoperative, postoperative, and last follow‑up radiographs. At the last follow‑up, patients were evaluated clinically with Hannover scoring system.

Results: The decrease in AP tibiofibular distance was statistically significant postoperatively in Weber Type B and C fractures. The mean preoperative AP tibiofibular distance which was 7.1 mm decreased to 3.6 mm after operation. There was no statistically significant relation between the amount of decrease and fracture type, either Weber B or C. At the same time, the AP tibiofibular distance did not change at the last follow‑up. At the last follow‑up clinical evaluation, patient scores were ranging from 74 to 94, with a mean value of 86, which was designated as a fair result.

Conclusion: In ankle fractures, if diastasis of distal tibiofibular joint is present, syndesmosis should be fixed for both Weber Type B and C fractures. The most important predictor of good clinical outcome is accurate reduction of the syndesmosis.

Keywords: Ankle fracture, ankle instability, diastasis screw, syndesmosis