Comparison of Radiological, Functional and Plantar Pressure Disturbance Results of Two Different Surgical Techniques on Syndesmosis Injuries with Malleolus Fractures

Year 2022, Volume: 13 Issue: 4, 498 - 507, 01.10.2022

Yusuf Murat Altun Fuad Öken Nilgün Bek İbrahim Alper Yavuz Utku Gürhan

https://doi.org/10.31067/acusaglik.1064412

Abstract

Background and objectives
This study compared the clinical and radiological results of three cortex conventional metal screw fixation and EndoButton implant techniques. We applied dynamic pedobarographic analysis to the cases to reveal the effect of the postoperative functional levels on the gait and plantar pressure distribution parameters and to determine the differences between the groups.
Materials and methods
In our retrospective study, 42 patients were evaluated in two groups, divided into metal screw (Group I; n=24) and button-stitch implant technique (Group II; n=18). After the groups were formed, the functional and clinical outcomes of the patients were evaluated and measured prospectively by an investigator blinded to the surgical procedures of the patients clinically and radiologically.
Results
We found the AOFAS score significantly higher in the EndoButton group (p=0.041), while the Weber and Freiburg scores were similar between the two groups (p=0.07 and p=0.49, respectively). When the plantar pressure distribution analyzes of the operated sides were examined, the loading percentages in the forefoot and midfoot were found to be statistically significantly higher in the metallic screw group providing static fixation, while the percentage of lateral heel loading was found to be statistically significantly lower. The medial heel loading percentage was also lower in the screw group, but no statistically significant difference was detected.

Conclusions
We observed that the conventional screw static fixation technique used to repair syndesmosis injuries causes limitation in ankle dorsiflexion, increases the pressure percentages in the forefoot and midfoot, and causes a later return to work/daily life.

Keywords

ankle fracture, syndesmosis outcome, syndesmotic ınjury

References

• D. P. et al Kennedy JG, Soffe KE, “Evaluation of the syndesmotic screw in low Weber C ankle fractures.,” J OrthopTrauma, vol. 14, pp. 359–366, 2000.
• Raahave D, “Postoperative wound infection after implant and removal of osteosynthetic material,” ActaOrthopScand, vol. 47, pp. 28–35, 1976.
• C. N. Richards RH, Palmer JD, “Observations on removal of metal implants,” Injury, vol. 23, pp. 25–28, 1992.
• B. OL, D. DR, and O. WT, “Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures.,” J. Orthop. Trauma, 2001.
• T. Marqueen, J. Owen, G. Nicandri, J. Wayne, and J. Carr, “Comparison of the syndesmotic staple to the transsyndesmotic screw: A biomechanical study,” Foot Ankle Int., 2005.
• M. R. Andersen, F. Frihagen, J. C. Hellund, J. E. Madsen, and W. Figved, “Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury,” J. Bone Jt. Surg. - Am. Vol., 2018.
• A. Tucker, J. Street, D. Kealey, S. McDonald, and M. Stevenson, “Functional outcomes following syndesmotic fixation: A comparison of screws retained in situ versus routine removal - Is it really necessary?,” Injury, 2013
• B. Thornes, F. Shannon, A.-M. Guiney, P. Hession, and E. Masterson, “Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes.,” Clin. Orthop. Relat. Res., 2005.
• M. R. Andersen, F. Frihagen, J. C. Hellund, J. E. Madsen, and W. Figved, “Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury,” J. Bone Jt. Surg. - Am. Vol., 2018.
• Qamar, Faisal, Anish Kadakia, and Balachandran Venkateswaran. "An anatomical way of treating ankle syndesmotic injuries." The Journal of foot and ankle surgery 50.6 (2011): 762-765.
• R. B. Rigby and J. M. Cottom, “Does the arthrex tightrope® provide maintenance of the distal tibiofibular syndesmosis? A 2-year follow-up of 64 tightropes® in 37 patients,” J. Foot Ankle Surg., 2013.
• A. Anand, R. Wei, A. Patel, V. Vedi, G. Allardice, and B. S. Anand, “Tightrope fixation of syndesmotic injuries in Weber C ankle fractures: a multicentre case series,” Eur. J. Orthop. Surg. Traumatol., 2017.
• J. De Vil, F. Bonte, H. Claes, W. Bongaerts, K. Verstraete, and R. Verdonk, “Bolt fixation for syndesmotic injuries,” Injury, 2009
• I. Kaftandziev, M. Spasov, S. Trpeski, B. Zafirova-Ivanovska, and B. Bakota, “Fate of the syndesmotic screw—Search for a prudent solution,” Injury, 2015
• A. Stiene, C. E. Renner, T. Chen, J. Liu, and N. A. Ebraheim, “Distal Tibiofibular Syndesmosis Dysfunction: A Systematic Literature Review of Dynamic Versus Static Fixation Over the Last 10 Years,” Journal of Foot and Ankle Surgery. 2019.
• Q. Liu, G. Zhao, B. Yu, J. Ma, Z. Li, and K. Zhang, “Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle: a finite element study,” Knee Surgery, Sport. Traumatol. Arthrosc., 2016.
• K. C. Walley, K. J. Hofmann, B. T. Velasco, and J. Y. Kwon, “Removal of Hardware After Syndesmotic Screw Fixation: A Systematic Literature Review,” Foot and Ankle Specialist. 2017.
• O. Kocadal, M. Yucel, M. Pepe, E. Aksahin, and C. N. Aktekin, “Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries,” Foot Ankle Int., 2016