Reduction and fixation of anterior inferior tibiofibular ligament avulsion fracture without syndesmotic screw fixation in rotational ankle fracture

Abstract

Objective We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture without syndesmotic screw fixation in rotational ankle fracture. Methods We retrospectively reviewed 66 consecutive patients with displaced malleolar fracture combined with AITFL avulsion fracture. We performed reduction and fixation for the AITFL avulsion fracture when syndesmotic instability was present after malleolar fracture fixation. A syndesmotic screw was inserted only when residual syndesmotic instability was present even after AITFL avulsion fracture fixation. The radiographic parameters were compared with those of the contralateral uninjured ankles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were assessed 1 year postoperatively. Results Fifty-four patients showed syndesmotic instability after malleolar fracture fixation and underwent reduction and fixation for AITFL avulsion fracture. Among them, 45 (83.3%) patients achieved syndesmotic stability, while 9 (16.7%) patients with residual syndesmotic instability needed additional syndesmotic screw fixation. The postoperative radiographic parameters were not significantly different from those of the uninjured ankles. The mean AOFAS score was 94. Conclusion Reduction and fixation of AITFL avulsion fracture obviated the need for syndesmotic screw fixation in more than 80% of patients with AITFL avulsion fracture and syndesmotic instability.

Comparison the treatment of anterior inferior tibiofibular ligament anatomical repair and syndesmosis screw fixation for syndesmotic injuries in ankle fracture

“…Our radiographic results agreed with two previous studies [ 30 , 41 ] which showed that AITFL repair had an important part in maintenance of syndesmotic reduction and the repair of AITFL was a reliable fixation. Furthermore, Kee J et al [ 5 ] shown that AITFL anatomical repair fixation has better radiographic outcomes and obviated the need for syndesmotic screw fixation in more than 80% of patients with syndesmotic instability.…”

“…Syndesmosis screw fixation is the most popular treatment option for ankle fracture combined with syndesmotic injury [ 5 ]. However, this method is a static fixation and becomes controversial currently because it has a high complication concern [ 6 ].…”

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

“…Consequently, Littlechild advocated that consideration should also be given to reconstruction of the AITFL to augment the syndesmosis fixation, which may provide a stronger restoration of ankle stability compared to repairing the posterior inferior tibiofibular ligament (PITFL) in isolation, for example, by fixation of a posterior malleolus avulsion fracture [77]. In total, we found 13 publications recommending open repair and augmentation of the AITFL [2,11,20,28,58,77,80,98,119,135,140,167,170].…”

Open Reduction and Fixation of Lateral Malleolus and Syndesmosis for Ankle Re-Fracture

“…Recently, there has been an interest in fixation of this "Chaput fragment" or "anterior malleolus", theorizing that fixation of the fractured anterior tibial fragment along with the attached anteroinferior tibiofibular ligament (AITFL) will restore tibial incisura and improve syndesmotic reduction. 3,4…”

“…Sometimes, the syndesmotic injury can be accompanied with a bony avulsion. 3 When this involves the posterior malleolus (PM), the posteroinferior tibiofibular ligament (PITFL) has been shown to remain attached to the posterior malleolus fragment. Thus, reduction of this fracture fragment reconstructs the tibial incisura and restores syndesmotic reduction by effectively repairing the PITFL attachment.…”