Comparing Different Surgical Techniques for Addressing the Posterior Malleolus in Supination External Rotation Ankle Fractures and the Need for Syndesmotic Screw Fixation

2017 ◽  
Vol 56 (4) ◽  
pp. 730-734 ◽  
Author(s):  
Mengnai Li ◽  
Rachel C. Collier ◽  
Brian W. Hill ◽  
Nathaniel Slinkard ◽  
Thuan V. Ly
Keyword(s):  
Screw Fixation ◽  
External Rotation ◽  
Surgical Techniques ◽  
Ankle Fractures ◽  
Syndesmotic Screw ◽  
Posterior Malleolus ◽  
Supination External Rotation

scholarly journals The Clinical, Radiologic Outcomes of Indirect Anteroposterior Screw Fixation for Posterior Malleolar Fracture in Rotational Ankle Fractures: Comparison with Syndesmosis Fixation

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0027
Author(s):  
Sunghyun Lee ◽  
Hoiyoung Kwon
Keyword(s):  
Functional Outcomes ◽  
Screw Fixation ◽  
Fragment Size ◽  
Fracture Repair ◽  
Ankle Fractures ◽  
Posterolateral Approach ◽  
Malleolar Fracture ◽  
Syndesmotic Screw ◽  
Posterior Malleolus

Category: Ankle Introduction/Purpose: The posterior malleolus is an important soft tissue attachment for the posterior inferior syndesmosis ligament. Recent studies suggested that direct fixation of a sizable posterior malleolar (PM) fracture through posterolateral approach would act to stabilize the syndesmosis and minimize or eliminate the need for trans-syndesmotic fixation. Indirect anteroposterior (AP) screw fixation was an alternative method, which represent relatively low complication. However, there were few studies to evaluate the stability of syndesmosis after indirect anteroposterior screw. The purpose of this study was to define the rate of syndesmotic instability after anteroposterior screw fixation and to compare to the clinical and anatomical outcomes with indirect reduction without fixation. Methods: We performed a retrospective review between 2009 and 2015 of consecutive patients who underwent surgery with sustained rotational ankle fractures including PM fractures. The exclusion criteria included age <18 years, diabetic neuropathy, tibial pilon fractures, previous ankle fracture repair and not available at minimum 1 year follow up. After the fibula and medial malleolar fracture fixation, the PM was fixed with an AP screw, leaving some of relatively smaller and indirect reduced PM fractures unfixed. Patients were sorted into 2 groups according to the presence (group F) or absence (group N) of AP screw fixation of PM. Then, both groups were divided according to the intraoperative necessity of syndesmotic fixation. The demographics, PM fragment size and syndesmosis widening comparing intact ankle on CT at 1 year postoperatively were recorded for each fracture. The functional outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Results: A total 126 patients met the study inclusion criteria and underwent analysis. Syndesmotic fixation was required in 17 of 78 (21.8%) and 24 of 88 (72.7%) in group F and N, respectively (p=0.012). Postoperative and follow-up FAOS scores were similar in the four subgroups. The tibiofibular distance on CT was greater in the patients without syndesmotic screw fixation in group F and N (p=0.036 and 0.021, respectively). Conclusion: Indirect AP screw fixation of the PM fracture in rotational ankle fractures might be support syndesmotic stability and, thus, lower the rate of syndesmotic fixation. Also, these patients have functional outcomes at least equivalent to outcomes for patients having syndesmotic screw fixation. However, in AP screw fixation group, syndesmosis widening was evaluated without syndesmosis fixation, which could be resulted in degenerative arthritis change. Therefore, our data demonstrate that indirect AP screw fixation of PM fracture alone could not restore syndesmotic stability perfectly.

scholarly journals Supination-external rotation ankle fractures: analysis of clinical results after syndesmotic screw removal

2017 ◽  
Vol 52 (6) ◽  
pp. 658-662
Author(s):  
João Mendonça de Lima Heck ◽  
Rosalino Guareschi Junior ◽  
Luiz Carlos Almeida da Silva ◽  
Marcelo Teodoro Ezequiel Guerra
Keyword(s):  
External Rotation ◽  
Clinical Results ◽  
Ankle Fractures ◽  
Syndesmotic Screw ◽  
Supination External Rotation

scholarly journals Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

2022 ◽  
Vol 11 (2) ◽  
pp. 331
Author(s):  
Markus Regauer ◽  
Gordon Mackay ◽  
Owen Nelson ◽  
Wolfgang Böcker ◽  
Christian Ehrnthaller
Keyword(s):  
Surgical Treatment ◽  
Systematic Reviews ◽  
Treatment Guidelines ◽  
Screw Fixation ◽  
External Rotation ◽  
Treatment Algorithm ◽  
Evidence Based ◽  
Posterior Malleolus ◽  
Anatomic Reduction

Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

Health Related Quality of Life in Patients with Supination-External Rotation Stage IV Ankle Fractures

2005 ◽  
Vol 26 (12) ◽  
pp. 1038-1041 ◽  
Author(s):  
Ryan Finnan ◽  
Luke Funk ◽  
Michael S. Pinzur ◽  
Steven Rabin ◽  
Laurie Lomasney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
External Rotation ◽  
Stage Iv ◽  
Ankle Fractures ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Rotation Stage ◽  
Supination External Rotation

Background: While open reduction of displaced ankle fractures generally is accepted as the standard of care, relatively little is known about the health related quality of life after treatment. It is generally accepted that clinical results of treatment for supination-external rotation stage IV ankle fractures are favorable. The goal of this investigation was to determine the relationship between clinical results and health-related quality of life outcome measures in a consecutive series of patients treated for closed supination-external rotation stage IV ankle fractures. Methods: Twenty-six of 156 patients who had operative treatment for closed, displaced supination-external rotation stage IV ankle fractures during a 9-year period, completed the Short Musculoskeletal Function Assessment (SMFA) outcome questionnaire. Radiographs and clinical records were reviewed to determine quality of operative repair, postoperative morbidity, and the development of post-traumatic arthritis. Results: There were no postoperative complications. Of the 26 patients who returned the SMFA questionnaires, 19 had “good,” and seven had “fair” reduction of their fractures. Six showed radiographic evidence of arthritis at followup. Study participants reported scores that were similar to the general population in five of the six domains of the SMFA. Their scores in the mobility index were statistically less favorable (23.72 vs. 13.61, p = 0.016) when compared to the general population. Participants with “good” operative reductions and no evidence of arthritis at followup showed no significant difference to the general population. Participants with either a “fair” operative reduction or evidence of postoperative arthritis at followup had less favorable scores in the daily activities (mean 13.45 vs. 11.82, p = 0.004), mobility (43.43 vs. 13.61, p = 0.001), dysfunction (32.89 vs. 12.70, p = 0.014), and bother (35.80 vs. 13.77, p = 0.020) domains, when compared to the general population. Conclusions: The results of this investigation suggest that patients with excellent radiographic operative reductions and no arthritis as early as 6 months after surgery sustain no lasting unfavorable effect on health related quality of life. Patients with “fair” radiographic reduction, or presence of arthritis or both at followup, are likely to have a negative effect on their quality of life.

Clinical Evaluation for Syndesmotic Screw Fixation of the Distal Tibiofibular Diastasis in the Ankle Fractures

1993 ◽  
Vol 28 (5) ◽  
pp. 1758
Author(s):  
Chung Nam Kang ◽  
Jin Man Whang ◽  
Kwon Jae Roh ◽  
Yeo Hon Yun ◽  
Han Chul Kim
Keyword(s):  
Clinical Evaluation ◽  
Screw Fixation ◽  
Ankle Fractures ◽  
Syndesmotic Screw

Relationship between fracture morphology of lateral malleolus and syndesmotic stability after supination-external rotation type ankle fractures

Injury ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1382-1387 ◽  
Author(s):  
Dong-Il Chun ◽  
Jahyung Kim ◽  
Yoon Seok Kim ◽  
Jae-Ho Cho ◽  
Sung-Hun Won ◽  
...  
Keyword(s):  
External Rotation ◽  
Fracture Morphology ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Supination External Rotation

scholarly journals Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Sohail Yousaf ◽  
Daniel Hay
Keyword(s):  
Systematic Review ◽  
External Rotation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Trials ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Stress Radiographs ◽  
The Stability ◽  
Supination External Rotation

Category: Trauma Introduction/Purpose: Differentiating stable isolated fibula fractures consistent with supination external rotation (SER) II ankle fractures from unstable SER IV fractures is essential in determining the need for surgical stabilisation. Stress radiographs are usually required to assess stability including gravity stress views (GSV) and external rotation views (ER). There is no clear consensus as to which modality is most useful to determine stability in a fracture clinic or emergency setting. In last, few years clinical uncertainty about the reliability has led researcher to focus on weight bearing radiographs (WB) .We aim to review recent literature regarding reliability of WB radiographs to estimate the stability of supination external rotation ankle fractures. Methods: A systematic review of the literature relating to radiological assessment of stability of supination external rotation ankle fractures was conducted according to PRISMA guidelines. The systematic review was prospectively registered with PROSPERO. It involved the following steps: Researching the question-Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture? Setting inclusion and exclusion criteria-All English language articles published in the including any Randomised controlled trials (RCT’s) and cohort studies. Data collection)– A literature search of Medline (PubMed), the Cochrane Bone, Joint, and Muscle Trauma Group trial register, the Cochrane central register of controlled trials, Embase and CINAHL was undertaken. The grey literature was searched. Key terms ‘supination external rotation fracture’, ‘stability’. Other variations to the key words were ‘weight bearing’, “axial load”, ‘stress x-rays’, ‘systematic reviews’ and ‘meta-analysis’. Results: A total of six studies met the inclusion criteria including 601 patients. No previous systematic review on stress radiographs including weight bearing was published. All studies concluded weight bearing radiographs is an easy, pain-free, safe and reliable method to estimate stability of isolated distal fibula fractures. No serious concerns or complications were reported. Conclusion: The evidence base contained many methodological limitations and most of the evidence was either level III or IV, and so any conclusion drawn from the research must be done so with caution. The studies suggest that GSV overestimates the instability which should be assessed with studies should focus on randomized controlled trials with narrow range of clinically useful outcome measures.

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