Weber C ankle fractures with tibiofibular diastasis: syndesmosis-only fixation (original) (raw)
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Syndesmosis Fixation in Bimalleolar Weber C Ankle Fractures
The Professional Medical Journal
Objective: To study the influence of size of screws for syndesmosis fixationin bimalleolar Weber C ankle fracture. Design: A prospective randomised controlled clinical trial. Place and Durationof Study: Orthopaedic Department at Combined Military Hospital Malir. Period: From October 2002 to September2005. Patients and Methods: 17 consecutive young active patients with Weber type C bimalleolar ankle fractureshaving syndesmotic injuries treated with open reduction and internal fixation were randomly allocated to two groups.1 2 In group I (n = 9) 3.5mm small fragment and in group II (n =8) 4.5mm large fragment AO cortical screws were usedfor syndesmotic fixation. All patients were followed up for 12 months. Fracture healing or loss of reduction ofsyndesmosis was taken as the study end point. Hardware loosening or breakage and need for hardware removal werethe outcome measures. Subjective and objective assessment with Olerud-Molander Ankle (OMA) scores , range of 1motion and radiographi...
Injury, 2016
Introduction: Ankle fractures comprise a highly morphologically and etiologically diverse group of injuries, which includes various degrees of impairment of bone and ligamentous structures. The complete synostosis and incomplete bony bridging of tibiofibular syndesmosis are among the local late complications after surgically treated ankle fractures. Patients and method: 269 patients were evaluated, including 203 patients with Weber type-B fractures, and 66 patients with Weber type-C fractures. All patients underwent ankle radiography at standard intervals (post-operatively, 6 and 12 weeks, 6 and 12 months). The final assessment one year after osteosynthesis was performed. The study analyzed age, sex, fracture morphology, the location and morphology of ossification, functional outcomes and subjective evaluations of patient status. Results: As risk factors there were found male sex, tibiotalar dislocation, syndesmotic screw fixation and Weber type-C fractures. The severity of subjective difficulties and objective status were not dependent on the size of distal tibiofibular synostosis. Discussion and conclusion: Despite relatively extensive imaging findings of complete synostosis or incomplete bony bridging, they only limited functional outcomes to a minimal extent.
CLINICAL APPLICATION OF THREE-COLUMN THEORY TO TIBIOFIBULAR SYNDESMOSIS INJURY AFTER ANKLE FRACTURES
Objective:- To explore the clinical effects of internal fixation on ankle fractures combined with tibiofibular syndesmosis injury under the guidance of three-column theory. Methods:- Clinical data of 54 patients with ankle fractures combined with tibiofibular syndesmosis injury, who were treated from June 2008 to May 2014, were retrospectively analyzed in this study. According to the characteristics of pathological anatomy and mechanisms of injury, ankle joint was divided into three columns. Above three columns were involved when ankle fractures combined with tibiofibular syndesmosis separation appeared. There were lateral column fracture in 54 sites, ligament injury of middle column in 26 sites, avulsion fracture of the middle column in 28 sites, ligament injury of inside column in 31 sites, and inside column fracture in 13 sites. At least two columns should be fixed after the three columns were injured. Visual analogue scale pain scores were recorded at 6 months after surgery. Imaging results were evaluated using modified Baird and Jackson evaluation criteria after fracture reduction and fixation. The function of ankle joint was assessed utilizing American Orthopaedic Foot and Ankle Society ankle-hindfoot score system. Results:- A total of 54 patients were followed up for 6-48 months (averagely 21 months). Healing time was 11-15 weeks (averagely 13.6 weeks). Visual analogue scale pain scores were between 0 and 6 (averagely 1.4). American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 82-100, averagely 96. Radiological evaluation of therapeutic effects showed 52 excellent cases and 2 good cases with an excellent and good rate of 100%. Conclusion:- Three-column classification for ankle fractures is a simple and comprehensive theory. Fixation of two columns can stabilize the tibiofibular syndesmosis after three columns were injured.
The aims of this study were to present a remedy for isolated Weber type B fractures using a new surgical technique, a specialized anatomical locking plate without inter-fragmentary lag screws, and an early weight-bearing protocol after surgery, as well as to evaluate the outcomes of this remedy. The study included 29 patients (17 males and 12 females; mean age, 40.8 years, range, 18 to 82 years) with a minimum 1-year follow-up period. Surgery was performed as fixation without inter-fragmentary lag screws using a specialized locking plate that was pre-anatomically contoured on the outline of the fibula. Tolerable weight bearing was permitted in the second postoperative week. Fractures were compared clinically and radiologically to the injured side and were rated according to the criteria reported by McLennan and Ungersma. The Foot and Ankle Outcome Score (FAOS) were used to evaluate functional results. In all patients, union was achieved without any loss of reduction or malunion. There were no infections or wound complications. According to the McLennan and Ungersma criteria, all patients were rated good radiologically; however, 2 were rated fair and 27 were good functionally. The mean FAOS score was 90.5 (range 62.4 to 100) at 1 year follow up after surgery. The fixation method without inter-fragmentary lag screws using a specialized anatomical locking plate and early postoperative weight bearing has the advantages of being an easy procedure with greater stability and provides good functional and radiological outcomes in patients with isolated Weber B ankle fractures.
The management of syndesmotic screw in ankle fractures
Acta bio-medica : Atenei Parmensis, 2018
BACKGROUND AND AIM There is a wide debate about the number, diameter and length of the syndesmotic screw and necessity and timing for its removal. The aim of this study is to determine whether functional and radiological outcomes differ in patients operated for Weber type B and C ankle fractures who had syndesmotic screws removed (group 1) compared to those who did not (group 2). Furthermore, authors want to define if it is really necessary to remove this device and its correct timing. MATERIALS AND METHODS 90 patients were eligible for the study. The functional outcomes were analyzed 1 year after surgery using OMAS and AOFAS scores. Radiographic evaluation assessed the tibiofibular distance immediately and 12 months after surgery and fracture's healing. RESULTS Clinical and x-rays results were similar in both groups at follow-up. DISCUSSION Fractures with interruption of syndesmosis are lesions that, if not well treated, are complicated by joint stiffness, residual pain and pos...
Outcome after fixation of ankle fractures with an injury to the syndesmosis
The Journal of Bone and Joint Surgery. British volume, 2009
The purpose of this study was to compare the clinical and radiological outcome of patients with intact, broken and removed syndesmosis screws after Weber B or C ankle fracture with an associated injury to the syndesmosis. We hypothesised that there would be no difference. Of a possible 142 patients who fulfilled our inclusion criteria, 52 returned for clinical and radiological assessment at least one year after surgery. Of these, 27 had intact syndesmosis screws, ten had broken screws, and 15 had undergone elective removal of the screw. The mean American Orthopaedic Foot and Ankle Society ankle/hindfoot score was 83.07 (sd 13.59) in the intact screw group, 92.40 (sd 12.69) in the broken screw group, and 85.80 (sd 11.33) in the removed screw group (p = 0.0466). There was no difference in clinical outcome of patients with intact or removed syndesmotic screws. Paradoxically, patients with a broken syndesmosis screw had the best clinical outcome. Our data do not support the removal of i...
Management of distal tibio-fibular syndesmotic injuries : A snapshot of current practice
2008
Management of syndesmotic injuries of the ankle remains controversial. A postal questionnaire was administered to 310 Orthopaedic consultants in the United Kingdom to explore these issues. One hundred and ninety seven (63.55%) replies were received. A large number of surgeons use intra-operative hook test as an aid to assess syndesmotic stability (68.8%). A clear majority favoured the use of a syndesmotic screw as the preferred method of fixation (97.4%). The opinion on technique was divided over issues including number of cortices fixed, position and type of screw used. Most surgeons (88.4%) do not compress the syndesmosis while inserting the screw. Very few surgeons (8.5%) allow full weight bearing immediately after surgery. The survey establishes an overview of current practice of management of syndesmotic ankle injuries.
Syndesmotic diastasis and it’s relation to the functional outcome in ankle fractures
International Journal of Orthopaedics Sciences, 2021
Ankle fractures are among the most common injury treated by orthopaedic surgeons. Syndesmotic injuries represent the severity of the ankle injuries. However, they are difficult to evaluate, have a lengthy recovery period, and may disrupt normal joint functioning if not appropriately treated. These ankle injuries are disastrous if not appropriately treated specially to athletes and those engaged in heavy work on irregular surfaces. Hence treating these ankle injuries are of utmost importance. The aim of this study was to assess the functional outcome in ankle fractures with syndesmotic diastasis and without syndesmotic diastasis. To provide guidelines for intra-operative assessment of syndesmotic stability. To find out the complications occurring in each group. This was a prospective observational study conducted in yenepoya medical college hospital from October 2017 to October 2020. In this study 42 patients were treated and each equally were divided into two groups with syndesmotic injury and without syndesmotic injury. Open reduction and internal fixation with locking / one third tubular plate with 3.5 system for lateral malleolus and 4 mm CC screws for medial malleolus for fractures without syndesmotic injury and fracture with syndesmotic injury additional 4mm screw was put, which was evaluated. Diagnosing the syndesmotic instability preoperatively wasn't adequate. However when combined with intraoperative assessment by checking for translational movements and cottons test; it was found to be more reliable. Open reduction and anatomical fixation is required to obtain good results. A simple syndesmotic screw will suffice the job and the screw needs to be removed before weight-bearing in order to avoid screw breakage. To conclude, the functional outcome scores were lower in syndesmotic group. However, we need to assess the functional outcomes in a longer time frame to see if any statistically significant difference actually exists or not.