Syndesmosis fixation in supination-external rotation ankle fractures. Long-Term results of a prospective randomised study.

BACKROUND: The clinical relevance and treatment of syndesmosis injury in supination-external rotation (SER) ankle fractures are controversial. METHODS: After malleolar fixation 24 SER 4 ankle fracture patients with unstable syndesmosis in external rotation stress test were randomised to syndesmosis transfixation with a screw (13 patients) or no fixation (11 patients). Mean follow-up time was 9.7 years (range, 8.9-11.0). The primary outcome measure was the Olerud-Molander Ankle Outcome Score (OMAS). Secondary outcome measures included ankle mortise congruity and degenerative osteoarthritis, 100-mm visual analogue scale for function and pain, RAND 36-Item Health Survey, and range of motion. RESULTS: Mean OMAS in the syndesmosis transfixation group was 87.3 (SD 15.5) and in the no-syndesmosis-fixation group 89.0 (SD 16.0) (difference between means 1.8, 95% CI -10.4-14.0, P = 0.76). There were no differences between the two groups in secondary outcome measures. CONCLUSION: With the numbers available, SER 4 ankle fractures with unstable syndesmosis can be treated with malleolar fixation only, with good to excellent long-term functional outcome.

Results of Arthroscopy-Assisted TightRope Repair of Acromioclavicular Dislocations.

BACKGROUND: The present study assessed results of arthroscopy-assisted TightRope (Arthrex, Naples, FL, USA) repair of acute Rockwood grade III and V acromioclavicular (AC) dislocations. METHODS: We retrospectively reviewed the medical records of 57 patients with AC dislocations treated with TightRope fixation: 15 Rockwood grade III and 42 grade V. Functional results were assessed using the Constant score, and Disabilities of Arm, Shoulder and Hand (DASH) and RAND 36-ltem Health Survey scores after a mean 2.6 years of follow-up (range 1.0 years to 4.5 years). Radiographic results were assessed using the AC joint coracoclavicular (CC) distance. RESULTS: Postoperative radiographs showed anatomical AC joint reduction in all patients. In nine patients, fixation failed before 6 weeks postoperatively, mainly as a result of suture breakage. For the remaining 47 patients, CC distance was well maintained at 6 weeks. At follow-up, mean (SD) CC distance was significantly increased compared to the contralateral side or postoperative radiographs [17 (4) mm versus 10 (3) mm]. Mean DASH score was 9, Constant score was 88 and the RAND 36 score showed a quality of life similar to the Finnish reference population. CONCLUSIONS: Despite initial good reduction of grade III and V AC dislocations using TightRope fixation, subluxation often recurs after 6 weeks. Patients suffer minor subjective complaints that do not worsen the quality of life.

Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.

BACKGROUND: This study was designed to assess whether transfixion of an unstable syndesmosis is necessary in supination-external rotation (Lauge-Hansen SE/Weber B)-type ankle fractures. METHODS: A prospective study of 140 patients with unilateral Lauge-Hansen supination-external rotation type 4 ankle fractures was done. After bony fixation, the 7.5-Nm standardized external rotation (ER) stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. If the stress test was positive, the patient was randomized to either syndesmotic transfixion with 3.5-mm tricortical screws or no syndesmotic fixation. Clinical outcome was assessed using the Olerud-Molander scoring system, RAND 36-Item Health Survey, and Visual Analogue Scale (VAS) to measure pain and function after a minimum 1-year of followup. RESULTS: Twenty four (17%) of 140 patients had positive standardized 7.5-Nm ER stress tests after malleolar fixation. The stress view was positive three times on tibiotalar clear space, seven on tibiofibular clear space, and 14 times on both tibiotalar and tibiofibular clear spaces. There was no significant difference between the two randomization groups with regards to Olerud-Molander functional score, VAS scale measuring pain and function, or RAND 36-Item Health Survey pain or physical function at 1 year. CONCLUSION: Relevant syndesmotic injuries are rare in supination-external rotation ankle fractures, and syndesmotic transfixion with a screw did not influence the functional outcome or pain after the 1-year followup compared with no fixation.