Short and Middle Functional Outcome in the Static vs. Dynamic Fixation of Syndesmotic Injuries in Ankle Fractures: A Retrospective Case Series Study

Abstract

Background: Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. Methods: Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. Results: Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. Conclusion: The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis.

Syndesmotic fixation in Weber B ankle fractures: A systematic review

“…Alternatives to syndesmotic screws reported in the literature include suture-button devices [ 23 ], tightrope fixation, and antiglide fixation [ 24 ]. Pavone et al found that suture-button devices had comparable functional outcomes to screw fixation while having faster recovery times, higher foot dorsiflexion and forefoot supination and adduction [ 23 ].…”

“…Alternatives to syndesmotic screws reported in the literature include suture-button devices [ 23 ], tightrope fixation, and antiglide fixation [ 24 ]. Pavone et al found that suture-button devices had comparable functional outcomes to screw fixation while having faster recovery times, higher foot dorsiflexion and forefoot supination and adduction [ 23 ]. Willmott et al found that, among four Weber C fractures, one Maisonneuve fracture and one isolated syndesmotic disruption without fracture, tightrope fixation successfully reduced and maintained the distal tibiofibular syndesmosis and allowed the initiation of weightbearing by six weeks [ 25 ].…”