Comparison of Radiological, Functional and Plantar Pressure Disturbance Results of Two Different Surgical Techniques on Syndesmosis Injuries with Malleolus Fractures

Abstract

Background and objectives
 This study compared the clinical and radiological results of three cortex conventional metal screw fixation and EndoButton implant techniques. We applied dynamic pedobarographic analysis to the cases to reveal the effect of the postoperative functional levels on the gait and plantar pressure distribution parameters and to determine the differences between the groups.
 Materials and methods
 In our retrospective study, 42 patients were evaluated in two groups, divided into metal screw (Group I; n=24) and button-stitch implant technique (Group II; n=18). After the groups were formed, the functional and clinical outcomes of the patients were evaluated and measured prospectively by an investigator blinded to the surgical procedures of the patients clinically and radiologically.
 Results
 We found the AOFAS score significantly higher in the EndoButton group (p=0.041), while the Weber and Freiburg scores were similar between the two groups (p=0.07 and p=0.49, respectively). When the plantar pressure distribution analyzes of the operated sides were examined, the loading percentages in the forefoot and midfoot were found to be statistically significantly higher in the metallic screw group providing static fixation, while the percentage of lateral heel loading was found to be statistically significantly lower. The medial heel loading percentage was also lower in the screw group, but no statistically significant difference was detected.
 
 Conclusions
 We observed that the conventional screw static fixation technique used to repair syndesmosis injuries causes limitation in ankle dorsiflexion, increases the pressure percentages in the forefoot and midfoot, and causes a later return to work/daily life.