TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUBenwen ,  DINGZhenqi , HUANGGuofeng , LIUGuojun , CAIZhemin , DINGLuobin , LIXiang

The Center of Orthopaedics and Traumatology, the 175 th Hospital of Chinese PLA, Zhangzhou Fujian, 363000, P. R. China;

Corresponding?author：

DINGZhenqi, Email: dzqi@xmu.edu.cn

Keywords：

Ankle fracture; Pronation external rotation; Distal tibiofibular syndesmosis; Screw; Internal fixation

DOI：

10.7507/1002-1892.20160220

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Objective To evaluate the difference between using and not using syndesmotic screw to treat pronation external rotation (PER) ankle fracture combined with separation of distal tibiofibular syndesmosis. Methods Between April 2011 and October 2014, 46 cases of PER ankle fracture combined with separation of distal tibiofibular syndesmosis were treated, and syndesmotic screw was used in 24 cases (fixation group) and syndesmotic screw was not used in 22 cases (non-fixation group). There was no significant difference in gender, age, weight, cause of injury, side, injury to operation time, and fracture type between 2 groups (P > 0.05). The time for full weight-bearing, fracture healing time, and complications were recorded after operation. Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap (TBOL) and tibiofibular clear space (TBCS). Baird-Jackson score was used to evaluate functional recovery of the ankle. Results All incision healed by first intention without complications. The cases were followed up 13-18 months (mean, 15.2 months) in 2 groups. The time for full weight-bearing was 8-12 weeks (median, 11 weeks) in fixation group, which was significantly later than that in non-fixation group (range, 6-10 weeks; median, 8 weeks) (Z=-5.049, P=0.000). X-ray examination showed reduction of separation of distal tibiofibular syndesmosis. All fractures healed. The fracture healing time was (13.83±1.37) weeks in fixation group, and was (13.91±1.31) weeks in non-fixation group, showing no significant difference (t=-0.191, P=0.945). No separation of distal tibiofibular syndesmosis, delayed union, nonunion, loosening, or breakage of fixation devices was observed in 2 groups. There was no significant difference in TBOL, TBCS, Baird-Jackson score and the excellent and good rate between 2 groups (P > 0.05). Conclusion If the medial, lateral, and posterior structures of the ankle could be repaired according to injury, no significant influence on functional outcome of ankle or radiologic findings could be detected whether syndesmotic fixation is given or not in treating PER ankle fracture (exclude Maisonneuve fracture) combined with separation of distal tibiofibular syndesmosis.

Citation： WUBenwen, DINGZhenqi, HUANGGuofeng, LIUGuojun, CAIZhemin, DINGLuobin, LIXiang. TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1081-1084. doi: 10.7507/1002-1892.20160220 Copy

1.	?van den Bekerom MP, Kloen P, Luitse JS, et al. Complications of distal tibiofibular syndesmotic screw stabilization:analysis of 236 patients. J Foot Ankle Surg, 2013, 52(4):456-459.
2.	張述才, 楊晶, 楊廣忠, 等.踝關節骨折切開復位內固定后下脛腓聯合分離固定和未固定的療效比較.中國骨與關節損傷雜志, 2014, 29(10):1006-1008.
3.	Jones CR, Nunley JA 2nd. Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures. J Orthop Trauma, 2015, 29(5):245-249.
4.	De Vries JS, Wijgman AJ, Sierevelt IN, et al. Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg, 2005, 44(3):211-217.
5.	Tang CW, Roidis N, Vaishnav S, et al. Position of the distal fibular fragment in pronation and supination ankle fractures:a CT evaluation. Foot Ankle Int, 2003, 24(7):561-566.
6.	Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am), 1976, 58(3):356-357.
7.	Beumer A, Valstar ER, Garling EH, et al. Kinematics of the distal tibiofibular syndesmosis:radiosterometry in 11 normal ankles. Acta Orthop Scand, 2003, 74(3):337-343.
8.	Huber T, Schmoelz W, B?lderl A. Motion of the fibula relative to the tibia and its alterations with syndesmosis screws:A cadaver study. Foot Ankle Surg, 2012, 18(3):203-209.
9.	Liu Q, Zhao G, Yu B, et al. Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle:a finite element study. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4):1228-1235.
10.	Hamid N, Loeffler BJ, Braddy W, et al. Outcome after fixation of ankle fractures with an injury to the syndesmosis:the effect of the syndesmosis screw. J Bone Joint Surg (Br), 2009, 91(8):1069-1073.
11.	Kaftandziev I, Spasov M, Trpeski S, et al. Fate of the syndesmotic screw-Search for a prudent solution. Injury, 2015, 46 Suppl 6:S125-129.
12.	Kortekangas TH, Pakarinen HJ, Savola O, et al. Syndesmotic fixation in supination-external rotation ankle fractures:a prospective randomized study. Foot Ankle Int, 2014, 35(10):988-995.
13.	王海鵬, 顧崢嶸, 劉云吉, 等.手術治療踝關節骨折伴三角韌帶損傷的療效觀察.中國修復重建外科雜志, 2015, 29(4):416-419.
14.	Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma, 2015, 29(12):574-578.
15.	何勇, 顧湘杰, 馬昕, 等.脛腓下聯合分離的生物力學研究.中華創傷骨科雜志, 2005, 7(10):943-947.
16.	Schepers T, Van Lieshout EM, de Vries MR, et al. Complications of syndesmotic screw removal. Foot Ankle Int, 2011, 32(11):1040-1044.
17.	Miller AN, Barei DP, Iaquinto JM, et al. Iatrogenic syndesmosis malreduction via clamp and screw placement. J Orthop Trauma, 2013, 27(2):100-106.
18.	Westermann RW, Rungprai C, Goetz JE, et al. The effect of suture-button fixation on simulated syndesmotic malreduction:a cadaveric study. J Bone Joint Surg (Am), 2014, 96(20):1732-1738.
19.	Song DJ, Lanzi JT, Groth AT, et al. The effect of syndesmosis screw removal on the reduction of the distal tibiofibular joint:a prospective radiographic study. Foot Ankle Int, 2014, 35(6):543-548.

1. ?van den Bekerom MP, Kloen P, Luitse JS, et al. Complications of distal tibiofibular syndesmotic screw stabilization:analysis of 236 patients. J Foot Ankle Surg, 2013, 52(4):456-459.
2. 張述才, 楊晶, 楊廣忠, 等.踝關節骨折切開復位內固定后下脛腓聯合分離固定和未固定的療效比較.中國骨與關節損傷雜志, 2014, 29(10):1006-1008.
3. Jones CR, Nunley JA 2nd. Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures. J Orthop Trauma, 2015, 29(5):245-249.
4. De Vries JS, Wijgman AJ, Sierevelt IN, et al. Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg, 2005, 44(3):211-217.
5. Tang CW, Roidis N, Vaishnav S, et al. Position of the distal fibular fragment in pronation and supination ankle fractures:a CT evaluation. Foot Ankle Int, 2003, 24(7):561-566.
6. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am), 1976, 58(3):356-357.
7. Beumer A, Valstar ER, Garling EH, et al. Kinematics of the distal tibiofibular syndesmosis:radiosterometry in 11 normal ankles. Acta Orthop Scand, 2003, 74(3):337-343.
8. Huber T, Schmoelz W, B?lderl A. Motion of the fibula relative to the tibia and its alterations with syndesmosis screws:A cadaver study. Foot Ankle Surg, 2012, 18(3):203-209.
9. Liu Q, Zhao G, Yu B, et al. Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle:a finite element study. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4):1228-1235.
10. Hamid N, Loeffler BJ, Braddy W, et al. Outcome after fixation of ankle fractures with an injury to the syndesmosis:the effect of the syndesmosis screw. J Bone Joint Surg (Br), 2009, 91(8):1069-1073.
11. Kaftandziev I, Spasov M, Trpeski S, et al. Fate of the syndesmotic screw-Search for a prudent solution. Injury, 2015, 46 Suppl 6:S125-129.
12. Kortekangas TH, Pakarinen HJ, Savola O, et al. Syndesmotic fixation in supination-external rotation ankle fractures:a prospective randomized study. Foot Ankle Int, 2014, 35(10):988-995.
13. 王海鵬, 顧崢嶸, 劉云吉, 等.手術治療踝關節骨折伴三角韌帶損傷的療效觀察.中國修復重建外科雜志, 2015, 29(4):416-419.
14. Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma, 2015, 29(12):574-578.
15. 何勇, 顧湘杰, 馬昕, 等.脛腓下聯合分離的生物力學研究.中華創傷骨科雜志, 2005, 7(10):943-947.
16. Schepers T, Van Lieshout EM, de Vries MR, et al. Complications of syndesmotic screw removal. Foot Ankle Int, 2011, 32(11):1040-1044.
17. Miller AN, Barei DP, Iaquinto JM, et al. Iatrogenic syndesmosis malreduction via clamp and screw placement. J Orthop Trauma, 2013, 27(2):100-106.
18. Westermann RW, Rungprai C, Goetz JE, et al. The effect of suture-button fixation on simulated syndesmotic malreduction:a cadaveric study. J Bone Joint Surg (Am), 2014, 96(20):1732-1738.
19. Song DJ, Lanzi JT, Groth AT, et al. The effect of syndesmosis screw removal on the reduction of the distal tibiofibular joint:a prospective radiographic study. Foot Ankle Int, 2014, 35(6):543-548.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS

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