SLR - February 2013 - Kessel
Reference: Gohar A. Naqvi, MCh, Patricia Cunningham, FFR (RCSI), Bernadette Lynch, DCR, HDipCT, Rose Galvin, PhD, and Nasir Awan, FRCS, FRCSI. Am J of Sports Med. Published Oct 10 2012.
Scientific Literature Review
Reviewed by: Nicole Kessel, DPM
Residency Program: St. John Hospital & Medical Center, Detroit MI
Podiatric Relevance:
Distal tibiofibular syndesmotic injuries are a challenge for surgeons to diagnosis and manage. It is estimated that 10 percent of all ankle fractures have a disruption of the syndesmosis. With syndesmotic reduction comes controversy with respect to the type and application of fixation.
Methods:
This is a cohort study of 46 patients treated for ankle syndesmotic diastases between July 2007 and June 2009. Single slice axial computed tomography scans of both ankles were performed at the level of the syndesmosis one centimeter above the tibial plafond. A greater than two millimeter widening of the syndesmosis compared with the untreated contralateral ankle was considered significant malreduction. Clinical outcomes were measured using the American Orthopaedics Foot and Ankle Society (AOFAS) and Foot and Ankle Disability Index (FADI) scores.
Results:
Forty-six patients participated in the study; 23 patients were in the TightRope group and 23 in the syndesmotic screw group. Mean follow-up time was 2.5 years. In the TightRope group, the mean width of the syndesmosis was 4.37 mm (SD, ±1.12mm) compared with 5.16 mm (SD±1.92 mm) (p = .30, t test) in the syndesmotic screw group (P= .01, t-test). Five out of the 23 syndesmotic screw group had malreduction, whereas none of the TightRope group showed malreduction on CT scan. Average time for full weightbearing was eight weeks in the TightRope group and 9.1 weeks in the syndesmotic screw group. There was no significant difference between the TightRope and syndesmotic screw group in the AOFAS or FADI score.
Conclusions:
Syndesmotic malreduction is an important independent predictor of clinical outcomes in ankle fractures. This study demonstrated that the TightRope resulted in an accurate method of syndesmotic stabilization when compared with screw fixation.