title: Anatomic Fixation of Supination External Rotation Type IV Equivalent Ankle Fractures.
abstract: OBJECTIVE
  To compare radiographic and clinical outcomes of supination external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B2.1) treated with transsyndesmotic screw fixation with those treated with deltoid and posterior inferior tibiofibular ligament (PITFL) repair.
  
  
  METHODS
  Case series and single-surgeon retrospective analysis of a prospective database.
  
  
  METHODS
  Academic level I trauma center.
  
  
  METHODS
  Forty-five SER IV E ankle fractures fulfilled all inclusion/exclusion criteria with at least 12 months of radiographic follow-up.
  
  
  METHODS
  Deltoid and PITFL repair in addition to lateral malleolus fixation compared with transsyndesmotic screw fixation.
  
  
  METHODS
  Syndesmotic reduction compared with contralateral extremity on a postoperative computed tomography scan and maintenance of reduction based on final postoperative radiographs [medial clear space (MCS) and tibiofibular clear space (TCS)].
  
  
  RESULTS
  There was no significant difference in mean postoperative TCS, MCS, or change in TCS or MCS between the cohorts. The anatomic treatment group had significantly better postoperative syndesmotic reduction compared with the transsyndesmotic cohort (7.4% vs. 33.3%; P = 0.02). Fourteen patients in the transsyndesmotic screw cohort underwent removal compared with 3 patients in the anatomic cohort who required secondary procedures. The transsyndesmotic screw cohort had statistically significant better mean dorsiflexion of ankle (mean 20 vs. 17 degrees; P = 0.02).
  
  
  CONCLUSIONS
  This comparison of treatment strategies for SER IV E ankle fractures has shown an improvement in immediate postoperative syndesmotic reduction and the elimination of reoperation for removal of transsyndesmotic screws in patients treated with PITFL repair. Previous research has shown a good correlation between functional outcomes and syndesmotic reduction; however, further investigation into the functional outcomes of these patients is necessary to determine the future clinical impact of this anatomic fixation strategy.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Orthopaedic Trauma Service, Cedar Sinai Medical Center, Los Angeles, CA; †United States Air Force, Landstuhl, Germany; ‡Orthopaedic Trauma Service, University of Texas, Houston, TX; §Hospital for Special Surgery, New York, NY; ‖Boston University Medical School, Boston, MA; and ¶Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, New York, NY.
authors.forename: Milton M T
authors.initials: MM
authors.lastname: Little
authors.forename: Marschall B
authors.initials: MB
authors.lastname: Berkes
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Schottel
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Garner
authors.forename: Lionel E
authors.initials: LE
authors.lastname: Lazaro
authors.forename: Jacqueline F
authors.initials: JF
authors.lastname: Birnbaum
authors.forename: David L
authors.initials: DL
authors.lastname: Helfet
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012399:Rotation; D013484:Supination; D016896:Treatment Outcome; D055815:Young Adult