SLR - May 2013 - Salil Singh
Reference: Symeonidis PD, Iselin LD, Chehade M, Stavrou P. Common Pitfalls in Syndesmotic Rupture Management: A Clinical Audit. Foot and Ankle International, Volume 34, Number 3 January 18, 2013.
Scientific Literature Review
Reviewed by: Salil Singh, DPM
Residency Program: Temple University Hospital Health Systems
Podiatric Relevance: Syndesmotic disruption is a common ailment seen with patients suffering acute and chronic ankle injuries. These can be related to ankle fracture pathology or isolated injuries. Untreated or delayed diagnosis can have a debilitating clinical affect. This study investigated the incidence of delayed diagnosis and unplanned syndesmotic reoperations.
Methods: The study design was a retrospective cohort study at a level 1 trauma center over a 6.5 year period with a minimum follow-up of two years. Age, gender, fixation (screw diameter/number of cortices), level of surgeon experience, timing of surgery and length of hospital stay were all analyzed.
Results: A total of 824 ankle injury patients were observed over the study period. Seventy cases involved a syndesmotic operation (8.5 percent incidence). Sixty-three of these were seen with ankle fractures and the remaining seven were solely ligamentous. Unplanned reoperations occurred in 19 of 70 cases. The average time to fixation was 7.6 days and the reoperation average time was 22 days.
Conclusions: The reoperation rate was not related to type of injury, screw diameter, number of purchased cortices, type of fixation or experience of the surgeon. However, working “after hours” and on weekends was related to a poorer outcome. The authors felt that suspecting syndesmotic injury, evaluating/documenting intraoperative stability, and anatomic reduction of fibula in the incisura fibularis were highly important steps in management of syndesmotic injuries.