• Tzu-Cheng Yang, Yun-Hsuan Tzeng, Chien-Shun Wang, Chun-Cheng Lin, Ming-Chau Chang, and Chao-Ching Chiang.
• Division of Orthopaedic Trauma; Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, 201, Sec.2, Shih-Pai Rd. Taipei 112, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University. Electronic address: max7271033@gmail.com.
• Injury. 2021 Mar 1; 52 (3): 638-643.

IntroductionThis retrospective study aimed to report outcomes of fixation of bi-malleolar or tri-malleolar fractures combined with syndesmotic injury with or without posterior malleolar fracture (PMF), and to ascertain whether syndesmotic screw removal at 6 to 8 weeks or 3 months postoperatively is more beneficial.MethodsWe retrospectively reviewed patients who received open reduction and internal fixation for bi-malleolar (without PMF) or tri-malleolar ankle fracture (with PMF) with syndesmotic injury between January 2013 and December 2017 with at least 24 months of postoperative follow-up. All patients suffered syndesmotic instabilities and were treated using a syndesmotic screw without PMF fixation. Patients with bi-malleolar fracture with syndesmotic screw removal at 6 to 8 weeks postoperatively were included in Group I, tri-malleolar fracture with syndesmotic screw removal at 6 to 8 weeks in Group II, and tri-malleolar fracture with syndesmotic screw removal at 3 months in Group III. Demographic data, clinical and radiographic outcomes were analyzed.ResultsA total of 113 patients were included (Group I, n=47; Group II, n=43; Group III, n=23). Average size of PMF was 14% in patients with tri-malleolar fractures (Groups II and III). No significant difference in ankle functional outcome among groups was observed. The recurrence rate of syndesmotic instability was 10.6% in Group I, 20.9% in Group II, and 8.7% in Group III. Although the difference in recurrence rates of syndesmotic instability among three groups was not statistically significant (P=0.264), Group II showed more interval change in tibiofibular clear space between initial postoperative radiographs and last follow-up radiographs (P=0.028) compared to the other two groups. Fracture union was achieved in all patients without screw breakage.ConclusionWe suggest that the better timing for syndesmotic screw removal is 3 months, instead of 6 to 8 weeks postoperatively, to reduce the risk of recurrence of syndesmotic instability for tri-malleolar fracture without posterior fragment fixation.Level Of EvidenceLevel III- Case-control study.Copyright © 2020 Elsevier Ltd. All rights reserved.

15 keywords...

hide…