Syndesmosis Fixation: A Comparison of Three and Four Cortices of Screw Fixation Without Hardware Removal

Moore, Joel; Shank, John R.; Morgan, Steven J.; Smith, Wade R.

doi:10.1177/107110070602700801

Cited by 139 publications

(90 citation statements)

References 28 publications

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“…1). Therefore, 12 studies were finally included [23][24][25][26][27][28][29][30][31][32][33][34] and are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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Internal fixation of distal tibiofibular syndesmotic injuries: a systematic review with meta-analysis

Wang

et al. 2013

International Orthopaedics (SICOT)

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No consensus had been reached about the optimal method for syndesmotic fixation. The present study analysed syndesmotic fixation based on the highest level of clinical evidence in order to obtain more reliable results. Medline, Embase and Cochrane database were searched through the OVID retrieval engine. Manual searching was undertaken afterward to identify additional studies. Only randomized controlled trials (RCT) and prospective comparative studies were selected for final inclusion. Study screening and data extraction were completed independently by two reviewers. All study characteristics were summarized into a table. The extracted data were used for data analysis. Twelve studies were finally included: six of them were RCTs, two were quasi-randomized studies and four were prospective comparative studies. Four comparisons with traditional metallic screw were identified in terms of bioabsorbable screws, tricortical fixation method, suture-button device as well as non-fixation choice in low syndesmotic injuries. Both absorbable screws and the tricortical fixation method showed almost no better results than traditional quadricortical metallic screw (p>0.05). Additionally, existing studies could not illustrate their efficiency of reducing hardware removal rate. The suture button technique had significantly better functional score (p=0.003), ankle motion (p=0.02), time to full weightbearing (p<0.0001) and much less complications (p=0.0008) based on short and intermediate term follow-up data. Transfixation in low syndesmotic injuries showed poorer results than the non fixed group in all outcome measurements, but didn't reach a significant level (p>0.05). The present evidence still couldn't find superior performance of the bioabsorbable screw and tricortical fixation method. Their true effects in decreasing second operation rate need further specific studies. Better results of the suturebutton made it a promising technique, but it still needs long-term testing and cost-efficiency studies. The patients with low syndemotic injuries should be well assessed before fixation determination and the indication of screw placement in such conditions needs to be further defined.

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“…1). Therefore, 12 studies were finally included [23][24][25][26][27][28][29][30][31][32][33][34] and are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Moore et al [28] reported that three cortical fixation was associated with more loss of reduction occurrence and contributed to its inadequate fixation strength. However our data analysis found neither significant difference of loss of reduction nor total complication incidence between the two methods.…”

Section: Discussionmentioning

confidence: 99%

Internal fixation of distal tibiofibular syndesmotic injuries: a systematic review with meta-analysis

Wang

et al. 2013

International Orthopaedics (SICOT)

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“…No advantage of the tricortical method over the quadricortical one, 3.5 mm screws over 4.5 mm screws, flexible over rigid fixation or a specific timing of hardware removal has been found. The foot position during the fixation does not seem to be of clinical importance, either [21][22][23][24]. These findings were reflected in the survey results.…”

Section: Discussionmentioning

confidence: 96%

“…Nie udo wod nio no prze wagi ze spo leń trój ko ro wych nad czte ro ko ro wy mi, śrub o śred ni cy 3,5 nad 4,5 mm, ze spo leń ela stycz nych nad sztyw ny mi, cza su usu nię cia śrub wię zo zro stowych. Ta kże po zy cja sto py pod czas ze spa la nia wię -zo zro stu wy da je się nie mieć zna cze nia kli nicz ne go [21][22][23][24]. Zna la zło to od zwier cie dle nie w wy ni kach an kie ty.…”

Section: Discussionunclassified

Methods of Diagnosis and Treatment of Ankle Fractures - The Opinion of Members and Supporters of the Polish Foot and Ankle Society

Kołodziej

Napiontek²

2011

Ortopedia, traumatologia, rehabilitacja

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STRESZCZEnIEWstęp. Pra cę opar to na wy ni kach ba da nia an kie to we go prze pro wa dzo ne go wśród uczest ni ków III Kon gresu Pol skie go To wa rzy stwa Sto py i Sta wu Sko ko wo -Go le nio we go (Po lish Fo ot and An kle So cie ty -PF&AS), któ ry od był się w Ja star ni w dniach 22-24 kwiet nia 2010 ro ku.Ma te riał i me to dy. Wy ko rzy sta no opis kli nicz ny i ob raz ra dio lo gicz ny hi po te tycz ne go pa cjen ta, z ty po wym zła ma niem ko stek go le ni, aby okre ślić spo so by dia gno sty ki i le cze nia tych ura zów sto so wa ne w Pol sce. Uczestni ka mi ba da nia by li le ka rze or to pe dzi. Roz pro wa dzo no 85 an kiet, na któ re uzy ska no 54 od po wie dzi (63%).Wy ni ki i Wnio ski. Więk szość an kie to wa nych: roz po zna ła wła ści wy me cha nizm zła ma nia, roz po zna ła typ zła ma nia, pre fe ro wa ła le cze nie ope ra cyj ne, ale nie po tra fi ła za sto so wać kla sy fi ka cji AO. Od po wie dzi na te mat kon tro li ra dio lo gicz nej po ope ra cji nie uwzględ nia ły dłu gie go cza su ob ser wa cji, a pro po no wa ne me to dy ob razo wa nia uszko dzeń wię zo zro stu pisz cze lo wo -strzał ko we go na le ży uznać za nie wy star cza ją ce. Po da ny w od powie dziach czas i sto pień ob cią ża nia koń czy ny po ope ra cji mie ścił się w stan dar dzie po stę po wa nia. Pro po zy cje pro fi lak ty ki prze ciw za krze po wej rów nież od po wia da ły przy ję tym stan dar dom Słowa kluczowe: złamania kostek goleni, więzozrost piszczelowo-strzałkowy, leczenie operacyjne SUMMARYBackground. The present paper is based on a survey distributed among the participants of the 3rd Congress of the Polish Foot and Ankle Society in Jastarnia on April 22-24, 2010.Material and methods. A clinical description and imaging data of a hypothetical patient with a typical ankle fracture were used to identify current methods of diagnosis and treatment of such injuries in Poland. The participants were orthopaedists. Eighty-five questionnaires were distributed and 54 (63%) were completed and returned.Results and Conclusions. Most respondents correctly recognized the fracture mechanism and identified the type of fracture. They preferred operative treatment, but were not able to apply the AO classification. The answers regarding post-operative radiological follow-up did not provide for long-term follow-up and the suggested methods of imaging to detect disruption of the tibiofibular syndesmosis were insufficient. The recommendations concerning the timing and staging of post-operative weight bearing as well as antithrombotic prophylaxis complied with current standards.

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“…a larger screw is stronger and easier to remove due to its large head, but there is no biomechanical advantage of a 4.5-mm screw over a 3.5-mm screw (thompson andGesink 2000, beumer et al 2005). a biomechanical study demonstrated that two syndesmosis screws could make a stronger construct than a single screw (Xenos et al 1995), three cortical syndesmosis screws allow some fibular movement and may not break or loosen compared to four screw cortices saltzman 2001, beumer et al 2005), but three or four cortices of fixation can be used to stabilize syndesmosis injuries (Moore et al 2006, Wikeroy et al 2010. previously, stability comparable to a tricortical 3.5-mm screw was achieved with two Kirchner wires (peter et al 1994), and it has been suggested that bioabsorbable syndesmosis screws are well tolerated and avoid the need for subsequent screw removal (thordarson et al 2001, hovis et al 2002).…”

Section: Mechanism Of Injury and Classificationmentioning

confidence: 99%

Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury

Pakarinen¹

2012

Acta Orthopaedica

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Syndesmosis Fixation: A Comparison of Three and Four Cortices of Screw Fixation Without Hardware Removal

Cited by 139 publications

References 28 publications

Internal fixation of distal tibiofibular syndesmotic injuries: a systematic review with meta-analysis

Internal fixation of distal tibiofibular syndesmotic injuries: a systematic review with meta-analysis

Methods of Diagnosis and Treatment of Ankle Fractures - The Opinion of Members and Supporters of the Polish Foot and Ankle Society

Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury

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