SLR - July 2018 - Christopher J. Collazo
Reference: Cherney SM, Cosgrove CT, Spraggs-Hughes AG, McAndrew CM, Ricci WM, Gardner MJ. Functional Outcomes of Syndesmotic Injuries Based on Objective Reduction Accuracy at a Minimum One-Year Follow-Up. J Orthop Trauma. 2018 Jan: 32(1) 43–51.Scientific Literature Review
Reviewed By: Christopher J. Collazo, DPM
Residency Program: Sanford Health Podiatric and Surgery Residency, Fargo, ND
Podiatric Relevance: The syndesmosis is commonly injured up to 45 percent of the time in ankle fractures. Studies have shown that a malreduced syndesmosis leads to increased contact pressure of the ankle joint, which can further lead to development of arthritis of the ankle. The purpose of this study was to evaluate clinical outcomes of patients with syndesmotic injuries to determine a relationship between reduction characteristics (i.e., widening, rotation) and patient demographics.
Methods: This was a Level II prospective study performed from April 2013 to April 2015. There were initially 69 patients with unilateral syndesmotic injuries with malleolar fractures, but after exclusion criteria and lost to follow-up, there were 48 patients followed up to at least one year. The syndesmosis was stabilized by one or two 3.5 quadricortical screws. Postoperative CT imaging was performed on all patients. Measurements of injured and uninjured syndesmosis were performed. Thresholds for malreduction were determined to be greater than 1.5 mm, 2 mm and 3 mm side to side and rotational malreduction of greater than 10 degrees and 15 degrees. Patients were also evaluated by the OMAS, SMFA and Numeric Pain Rating Scales.
Results: At the one-year follow-up, there was no significant difference between malreduced and reduced groups at 1.5, 2 and 3 mm in functional outcomes. There was also no significant difference between reduced and malreduced groups in rotational malreduction at 10 or 15 degrees in functional outcomes. In comparing patient populations, women had a significantly higher dysfunction than men in the SMFA. Patients with Medicaid were found to have significantly worse functional and pain scores than other groups of insurance.
Discussion: There was no significant difference found in objective measurements at one-year follow-up. The authors found that socioeconomic status was a more significant factor in the patient outcomes despite the quality of reduction in syndesmotic repair. It is important to stress that anatomical reduction of the syndesmosis is vital, but the study begs the question of how much a patient’s socioeconomic status truly plays into the overall outcome following injury. This study provides surgeons with further thought in the treatment of these individuals who are not improving functionally but have adequate surgical correction.