title: Open versus closed treatment of the fibula in Maissoneuve injuries.
abstract: BACKGROUND
  Masissoneuve fractures of the proximal half of the fibula are infrequently reported with only a few reports existing recommending closed reduction of the syndesmosis and percutaneous syndesmotic fixation. The purpose of this study was to compare the reduction obtained with open and closed reduction techniques of the fibular fracture with screw fixation of the syndesmosis.
  
  
  METHODS
  Twelve patients with acute displaced fibula fractures in the proximal one-half with syndesmotic disruption were enrolled in the study. One orthopedic traumatology team at the time of the study routinely treated these injuries with open reduction of the fibular fracture site with screw fixation of the syndesmosis. The other orthopedic traumatology service routinely treated these patients with a closed reduction of the syndesmosis and percutaneous syndesmotic screw fixation. All syndesmotic injuries were treated with two stainless steel screws. Postoperative reduction was analyzed with a CT scan and plain radiographs to assess rotation, AP translation of the distal fibula, medial and lateral joint space (talofibular space), talocrural angle and superior ankle joint space. Control data from 20 normal ankle CT scans collected in a previous study were used for comparison.
  
  
  RESULTS
  There were eight patients in the closed group and four in the open treatment group. A statistically significant difference in the reduction of the syndesmosis was found with the open group showing anatomic or near anatomic reductions in all patients while the closed fibular reduction group showed variable reductions. The talocrural angle was 12.8 degrees in the open group and 9.9 degrees in the closed group.
  
  
  CONCLUSIONS
  Proximal fibular fractures with syndesmotic disruption can be difficult to treat, especially with closed reduction and percutaneous fixation of the syndesmosis. In this limited series of patients, we found an unacceptable rate of malreduction with closed reduction and percutaneouso fixation and have now abandoned this technique.
authors.affiliation: USC Department of Orthopaedic Surgery, Orthopaedics, Los Angeles, CA 90033, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pelton
authors.forename: David B
authors.initials: DB
authors.lastname: Thordarson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Barnwell
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D015331:Cohort Studies; D005360:Fibula / Q000293:injuries*; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D057072:Intra-Articular Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome