Technique of syndesmotic screw insertion in weber type C ankle fractures

To find out impact of the position of the ankle during tightening of the syndesmotic screw used to fix syndesmotic disruption in bimalleolar Weber type C ankle fracture. A randomised controlled clinical trial. Orthopaedic Department at Combined Military Hospital Malir Karachi, from October 2002 to December 2005. We hypothesized that syndesmotic screw tightening with ankle in plantigrade position rather than 200 dorsiflexion would result in reduced range of dorsiflexion of the ankle joint postoperatively. Twenty-one consecutive young active patients with Weber type C bimalleolar ankle fractures having syndesmotic injuries treated with open reduction and internal fixation were randomly allocated to two groups. In group I [n=10] syndesmotic screw was inserted with ankle in 200 dorsiflexion and in group II [n=11] syndesmotic screw was inserted with ankle in plantigrade position. Patients were followed up for 12 months. Study end point was healing of the fracture. Subjective and objective assessment with Olerud-Molander Ankle [OMA] scores and bi-planar radiography was done. The range of ankle dorsiflexion postoperatively, hardware failure and need to remove the screw were the outcome measures. Comparing two groups using paired sample t-test, we did not find a statistically significant difference in postoperative range of ankle dorsiflexion between the two groups [p values > 0.05]. Differences between the two groups as regard the OMA scores, hardware failure and need to remove the screws were not significant either. Syndesmotic screw can be tightened with ankle in plantigrade or dorsiflexed positions without resulting in reduced range of ankle dorsiflexion postoperatively

Syndesmosis fixation in bimalleolar weber C ankle fractures; comparison of 3.5 and 4.5-mm screws

To study the influence of size of screws for syndesmosis fixation in bimalleolar Weber C ankle fracture. A prospective randomised controlled clinical trial. Orthopaedic Department at Combined Military Hospital Malir. From October 2002 to September 2005. 17 consecutive young active patients with Weber type C bimalleolar ankle fractures having syndesmotic injuries treated with open reduction and internal fixation were randomly allocated to two groups. In group I [n[1] = 9] 3.5mm small fragment and in group II [n[2]=8] 4.5mm large fragment AO cortical screws were used for syndesmotic fixation. All patients were followed up for 12 months. Fracture healing or loss of reduction of syndesmosis was taken as the study end point. Hardware loosening or breakage and need for hardware removal were the outcome measures. Subjective and objective assessment with Olerud-Molander Ankle [OMA] scores1, range of motion and radiographic criteria was done. Loss of reduction was not seen in any patient in both groups. Comparing two groups using paired sample t-test, there was no difference in screw loosening and breakage [p values > 0.05]. We did not find a statistically significant difference between range of motion [p = 1.08] and OMA score [p-value = 0.805]. Size of the syndesmotic screw does not appear to influence healing of syndesmotic injury. Screw loosening, which can result in reduced range of ankle motion postoperatively was more common in smaller screw group though the difference was not significant