title: Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomized study comparing two methods of syndesmosis fixation.
abstract: OBJECTIVE
  To assess short-term functional results in 2 types of syn-desmotic fixation, comparing the traditional rigid quadricortical syndesmotic screw fixation with a more dynamic tricortical screw fixation.
  
  
  METHODS
  : Prospective, randomized clinical study.
  
  
  METHODS
  University clinic, level 1 trauma center.
  
  
  METHODS
  Sixty-four patients with closed ankle fractures in which the syndesmosis was found to be unstable intraoperatively.
  
  
  METHODS
  The unstable syndesmoses were fixed with either one 4.5-mm cortical screw through both tibial cortices (n = 30) or two 3.5-mm cortical screws engaging only 1 cortex of the tibia (n = 34). The quadricortical screws were routinely removed after 2 months, whereas the tricortical screws were removed only in the case of discomfort. Rehabilitation was the same in both groups.
  
  
  RESULTS
  The Olerud Molander functional score (0-100) was significantly higher in the tricortical group (77 points) compared with the quadricortical group (66 points) (P = 0.025) at 3 months. After 1 year, however, the functional score was not significantly higher (P = 0.192) in the tricortical group (92.6 points) compared with the quadricortical group (85.7 points). Pain was significantly lower in the tricortical group (P = 0.017) after 3 months, but there was no significant difference after 1 year. There was no significant difference in dorsiflexion between the groups at any point of time. No losses of fixation were detected. The tricortical screws were removed in 2 patients due to migration.
  
  
  CONCLUSIONS
  Syndesmosis fixation with 2 tricortical screws is safe and improves early function. After 1 year, however, there were no significant differences between the 2 groups in functional score, pain, and dorsiflexion.
authors.affiliation: Ullevaal University Hospital, Oslo, Norway. per.hoiness@uus.no
authors.forename: Per
authors.initials: P
authors.lastname: Høiness
authors.forename: Knut
authors.initials: K
authors.lastname: Strømsøe
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology; D001863:Bone Screws; D005260:Female; D005360:Fibula / Q000293:injuries* / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D016474:Weight-Bearing