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Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Questions/Purposes

To confirm this observation we compared the Foot and Ankle Outcome Score (FAOS) and radiographic maintenance of fixation for fractures treated through direct posterior malleolar fixation versus syndesmotic screw fixation.

Methods

We prospectively followed 31 one patients with unstable ankle fractures treated with (1) open posterior malleolus fixation whenever the posterior malleolus was fractured, regardless of fragment size (PM group; n = 9); (2) locked syndesmotic screws in the absence of a posterior malleolar fracture (S group; n = 14); or (3) combined fixation in fracture-dislocations and more severe soft tissue injury (C group; n = 8). All patients had preoperative MRI confirming syndesmotic injury and an intact PITFL; postoperative and followup radiographs were evaluated for syndesmotic congruence. The minimum followup was 12 months (mean, 15 months; range, 12–31 months).

Results

Postoperative and followup FAOS scores were similar in the three groups. The tibiofibular clear space was greater in the S versus the PM group, but we found no other differences in the postoperative versus followup measurements between the PM, S, and C groups.

Conclusions

Syndesmotic fixation through the posterior malleolus and PITFL is maintained at followup, and these patients have functional outcomes at least equivalent to outcomes for patients having syndesmotic screw fixation.

Level of Evidence

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Dr. Stephen Lyman for work on the statistical portion of our study and Omesh Paul for assistance with data collection.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA

    Anna N. Miller MD, Robert J. Parker BS, David L. Helfet MD & Dean G. Lorich MD

  2. Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Eben A. Carroll MD

Authors
  1. Anna N. Miller MD
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  2. Eben A. Carroll MD
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  3. Robert J. Parker BS
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  4. David L. Helfet MD
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  5. Dean G. Lorich MD
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Corresponding author

Correspondence to Anna N. Miller MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Hospital for Special Surgery, New York, NY, USA.

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Miller, A.N., Carroll, E.A., Parker, R.J. et al. Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation. Clin Orthop Relat Res 468, 1129–1135 (2010). https://doi.org/10.1007/s11999-009-1111-4

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  • DOI: https://doi.org/10.1007/s11999-009-1111-4

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