Lagged Syndesmotic Fixation: Our Clinical Experience.
Ankle fractures are very common, and although algorithms are in place for osseous management, consensus has not been reached regarding treatment of associated ligamentous injuries. Although tibiofibular syndesmotic stabilization can be done using different forms of fixation, the biomedical literature has long emphasized the risk of long-term restriction of ankle mobility with the use of lagged transfixation. However, when reduction cannot be maintained with positional fixation, we found that lagging the syndesmotic screw helped to maintain the reduction without causing functional restriction. In this report, we describe our experience with patients who had undergone lagged tibiofibular transfixation and were available for short- to intermediate-term follow-up to assess ankle function. A total of 31 patients (32.63% of 95 consecutive patients) were available at a mean of 34.87 (range 18 to 52) months to complete the American Orthopedic Foot and Ankle Society ankle-hindfoot questionnaire. The mean score was 88.38 (range 42 to 100) points at a mean follow-up interval of 34.87 (range 18 to 52) months. Of 31 patients, 19 had an AOFAS score of 90 points, 9 an AOFAS score of 80 to 89 points, 2 an AOFAS score of 60 to 69 points, and 1 an AOFAS score of <60 points. Because all syndesmotic screws were placed using the lag technique, unrestricted motion compared with the uninjured limb was used as the endpoint. All subjects had unrestricted motion compared with the uninjured limb, refuting the assertion that lagged syndesmotic screw fixation confers more restriction in ankle kinematics than positional syndesmotic fixation.
Assistant Professor, Temple University School of Podiatric Medicine, Philadelphia, PA. Electronic address: kkwaadu@gmail.com.
Kwasi Yiadom
KY
Kwaadu
Fellowship Director, Philadelphia Foot and Ankle Fellowship, The Muscle, Bone, and Joint Center, Philadelphia, PA; Podiatric Residency Director, Aria Health Systems, Philadelphia, PA.
Justin James
JJ
Fleming
Postgraduate Year-2 Resident, Aria Health Systems, Philadelphia, PA.
Trudy
T
Salmon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology; D055815:Young Adult
ankle fracture; kinematics; lag screw fixation; ligamentous instability; malleolus; syndesmotic fixation; tibiofibular syndesmosis