Comparison of clinical efficacy of Hybrid fixation, single-screw and single-Tightrope in the treatment of ankle fractures complicated with Distal tibiofibular syndesmosis injury

Abstract

Background In the treatment of ankle fracture combined with distal tibiofibular syndesmosis injury, both screw fixation and Tightrope fixation are commonly used to restore the anatomical relationship of distal tibiofibular syndesmosis. In recent years, some studies have reported the use of hybrid fixation (Tightrope combined with screws) for the repairment of distal tibiofibular syndesmosis injury. However, there is a lack of literature reports comparing the clinical efficacy of screw fixation, Tightrope fixation and hybrid fixation.Purpose To explore whether there is any difference in the clinical efficacy of single screw fixation, single Tightrope fixation and hybrid fixation by comparing the imaging manifestations, AOFAS scores and VAS scores.Methods From January 2017 to January 2023, patients with ankle fracture combined with distal tibiofibular syndesmosis injury who were treated with single screw fixation, single Tightrope fixation, or hybrid fixation were retrospectively reviewed. Clinical evaluation included AOFAS score and VAS score. Imaging evaluation included medial malleolar space (MCS), tibiofibular clear space (TFCS) and tibiofibular overlap (TFO). All measurements were performed on anteroposterior ankle radiographs.Results There were 36 patients in single screw fixation group, 30 patients in single Tightrope fixation group and 18 patients in hybrid fixation group. All three groups had statistical similar clinical and imaging results. The hybrid fixation group was further divided into two subgroups: the group with removed screw(n = 8) and the group without removed screw(n = 8). Clinical and imaging outcomes were statistical similar in these two subgroups.Conclusion Comparing with single screw fixation and single Tightrope fixation, the hybrid fixation is comparably effective and has similar clinical efficacy. Considering that the configuration of the hybrid fixation is similar to that of the healthy ankle in terms of biomechanics, it may be helpful for early weight-bearing and can be used as an alternate method for distal tibiofibular syndesmosis fixation.