title: Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. harri.pakarinen@ppshp.fi
authors.forename: Harri J
authors.initials: HJ
authors.lastname: Pakarinen
authors.forename: Tapio E
authors.initials: TE
authors.lastname: Flinkkilä
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Ohtonen
authors.forename: Pekka H
authors.initials: PH
authors.lastname: Hyvönen
authors.forename: Martti T
authors.initials: MT
authors.lastname: Lakovaara
authors.forename: Juhana I
authors.initials: JI
authors.lastname: Leppilahti
authors.forename: Jukka Y
authors.initials: JY
authors.lastname: Ristiniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D012399:Rotation; D016896:Treatment Outcome; D055815:Young Adult