title: Effects of three- or four-cortex syndesmotic fixation in ankle fractures.
abstract: BACKGROUND
  There is no study comparing how Weber type C ankle fractures treated with either three- or four-cortex syndesmotic fixation affects the structure of the syndesmosis.
  
  
  METHODS
  In a retrospective study, 46 patients were separated into two groups: 22 patients with three-cortex fixation and 24 patients with four-cortex fixation. All of the patients were evaluated clinically and radiographically at least 1 year after removal of the syndesmosis screws.
  
  
  RESULTS
  There were three types of joint space obliteration: type 1, synostosis on plain radiographs; type 2, an incomplete bony bridge on magnetic resonance imaging with normal plain radiographs; and type 3, fibrous obliteration of the joint space. Although obliteration of the joint space was significant (P < .005) after four-cortex fixation, radiologic results did not affect the clinical outcome.
  
  
  CONCLUSIONS
  Four-cortex fixation for diastasis after an ankle fracture should not be a routine procedure. We advocate three-cortex fixation because the clinical results are no different and there is less syndesmotic space obliteration postoperatively.
authors.affiliation: Orthopedics, State Hospital, Yesilyurt, Izmir, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Karapinar
authors.forename: Onder
authors.initials: O
authors.lastname: Kalenderer
authors.forename: Levent
authors.initials: L
authors.lastname: Karapinar
authors.forename: Taskin
authors.initials: T
authors.lastname: Altay
authors.forename: Metin
authors.initials: M
authors.lastname: Manisali
authors.forename: Izge
authors.initials: I
authors.lastname: Gunal
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome