Tibiofemoral syndesmosis injury treated by temporary screw fixation and ligament repair.
Tibiofemoral syndesmosis injuries are common but have not been extensively researched. The primary objective of this study was to evaluate the outcomes after temporary screw fixation with ligament repair of these injuries. The secondary objective was to look for factors that could impact these outcomes. We hypothesised that this double fixation (screw+suture) would lead to good outcomes with minimal secondary opening of the syndesmosis upon screw removal.



This was a retrospective study of 285 patients with a tibiofemoral syndesmosis injury (01/2004-12/2011) who were treated by temporary tricortical or quadricortical screw fixation and ligament repair. The operated leg was unloaded for 6-8 weeks postoperative with the patient wearing a walking cast. The screw was removed in all patients before weight bearing was allowed. At follow-up, the range of motion, return to sports, pain, and functional scores (AOFAS and OMAS) were determined, and a radiological assessment was performed.



One hundred twenty-six patients were reviewed after a mean follow-up of 5.9±5.7years (2.9-10.5). Mean plantarflexion was 95% of the contralateral side and mean dorsiflexion was 93%. Return to sports occurred after a mean of 10weeks; 83% of patients returned to their pre-injury level of participation. Pain on VAS was 0.8/10 on average. The mean AOFAS and OMAS scores were both above 90 points. At the review, 4% of screws had broken. Diastasis was found in 5.6% of cases, osteoarthritis in 6.3% and an osteophyte in 11.1% of cases, but with no clinical repercussions. No risk factors were identified.



Treatment by temporary screw fixation and ligament repair leads to good objective results, confirming our hypothesis. However, there is little published data and no consensus on the fixation method or the need to remove the screw.



IV, retrospective, non-comparative.
Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
S
S
Steinmetz
Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
B
B
Puliero
Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
D
D
Brinkert
GMRC, service de santé publique, CHU de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
N
N
Meyer
Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
P
P
Adam
Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
F
F
Bonnomet
Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France; Laboratoire Icube-CNRS - UMR 7357, Illkirch, France. Electronic address: Matthieu.ehlinger@chru-strasbourg.fr.
M
M
Ehlinger
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology*; D001863:Bone Screws; D020878:Device Removal; D005260:Female; D005360:Fibula / Q000293:injuries*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D010003:Osteoarthritis / Q000209:etiology; D054850:Osteophyte / Q000209:etiology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D000068958:Return to Sport; D055815:Young Adult
Ankle; Distal tibiofibular joint; Syndesmosis screw