title: Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.
abstract: BACKGROUND
  This study compared mid-term functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation (SER) ankle fractures with intraoperatively confirmed syndesmosis disruption. Our hypothesis was that early-stage good functional results would remain and unfixed syndesmosis disruption in SER IV ankle fractures would not lead to an increased incidence of osteoarthritis.
  
  
  METHODS
  A prospective study of 140 operatively treated patients with Lauge-Hansen SER IV (Weber B) ankle fractures was performed. After bony fixation, the 7.5-Nm standardized external rotation 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. The patients were randomized to either syndesmotic screw fixation (13 patients) or no syndesmotic fixation (11 patients). After a minimum of 4 years of follow-up (mean, 58 months), ankle function and pain (Olerud-Molander, a 100-mm visual analogue scale [VAS] for ankle function and pain) and quality of life (RAND-36) of all 24 patients were assessed. Ankle joint congruity and osteoarthritis were assessed using mortise and lateral projection plain weight-bearing radiographs and magnetic resonance imaging (MRI; 3T) scans.
  
  
  RESULTS
  Improvement in Olerud-Molander score, VAS, and RAND-36 showed no significant difference between groups during the follow-up. In the syndesmotic transfixation group, improvements in all functional parameters and pain measurements were not significant, whereas in the group without syndesmotic fixation, the Olerud-Molander score improved from 84 to 93 (P = .007) and the pain (VAS) score improved from 11 to 4 (P = .038) from 1 year to last follow-up. X-ray or MRI imaging showed no difference between groups at the last follow-up visit.
  
  
  CONCLUSIONS
  With the numbers available, no significant difference in functional outcome or radiologic findings could be detected between syndesmosis transfixation and no-fixation patients with SER IV ankle fracture after a minimum of 4 years of follow-up.
  
  
  METHODS
  Level II, prospective comparative study.
authors: Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland tero.kortekangas@ppshp.fi.
authors: Tero H J
authors: TH
authors: Kortekangas
authors: Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Harri J
authors: HJ
authors: Pakarinen
authors: Omasairaala Oy, Helsinki, Finland.
authors: Olli
authors: O
authors: Savola
authors: Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
authors: Jaakko
authors: J
authors: Niinimäki
authors: Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
authors: Sannamari
authors: S
authors: Lepojärvi
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Pasi
authors: P
authors: Ohtonen
authors: Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Tapio
authors: T
authors: Flinkkilä
authors: Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Jukka
authors: J
authors: Ristiniemi
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000473:pathology / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012399:Rotation; D013314:Stress, Mechanical; D064232:Visual Analog Scale
keywords: Weber B; ankle fracture; fixation; stress test; supination-eversion; syndesmosis