Syndesmosis fixation in supination-external rotation ankle fractures : long-term results of a prospective randomised study

Abstract

<div lang="en" class="abs"><p class="abs_header">Abstract</p><p><em>Background:</em> The clinical relevance and treatment of syndesmosis injury in supination-external rotation (SER) ankle fractures are controversial.</p><p><em>Methods:</em> After malleolar fixation 24 SER 4 ankle fracture patients with unstable syndesmosis in external rotation stress test were randomised to syndesmosis transfixation with a screw (13 patients) or no fixation (11 patients). Mean follow-up time was 9.7 years (range, 8.9–11.0). The primary outcome measure was the Olerud-Molander Ankle Outcome Score (OMAS). Secondary outcome measures included ankle mortise congruity and degenerative osteoarthritis, 100-mm visual analogue scale for function and pain, RAND 36-Item Health Survey, and range of motion.</p><p><em>Results:</em> Mean OMAS in the syndesmosis transfixation group was 87.3 (SD 15.5) and in the no-syndesmosis-fixation group 89.0 (SD 16.0) (difference between means 1.8, 95% CI −10.4–14.0, P = 0.76). There were no differences between the two groups in secondary outcome measures.</p><p><em>Conclusions:</em> With the numbers available, SER 4 ankle fractures with unstable syndesmosis can be treated with malleolar fixation only, with good to excellent long-term functional outcome.</p></div>