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Foot Ankle Int. 2013 Mar;34(3):345-50. doi: 10.1177/1071100712470914. Epub 2013 Jan 18.

Common pitfalls in syndesmotic rupture management: a clinical audit.

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1
Aristotelian University of Thessaloniki, Thessaloniki, Greece.

Abstract

BACKGROUND:

Syndesmotic injuries occur in up to 11% of all ankle injuries. Whereas the optimal fixation of syndesmotic injuries remains controversial, pitfalls in their management can lead to poor outcomes.

MATERIALS AND METHODS:

This is a retrospective study of all ankle fractures operated on at a level 1 trauma center over a 7-year period. All cases with syndesmotic fixation were classified and patients' notes and x-rays were reviewed. The timing of definitive syndesmotic fixation, the type of fixation (screw size and number, number of cortices), and the number of unplanned, syndesmotic-related reoperations were recorded. Seventy syndesmotic ruptures were operated on during the study period.

RESULTS:

There were 19 unplanned reoperations. The 3 reasons for reoperation identified were failure to diagnose the syndesmotic injury 9/19 (47%), failure to achieve an anatomic reduction 6/19 (31%), and loss of reduction due to fixation failure 4/19 (21%). The type of fixation was not correlated with the failure rate, nor were the experience of the surgeon, the gender or the age of the patient.

CONCLUSIONS:

The reoperation rate for syndesmotic fixation may be higher than previously thought. In order to reduce the pitfalls in their treatment, we emphazise the importance of 3 critical points in the management of these injuries: suspect the injury, document the stability of the syndesmosis, and reduce the fibula anatomically.

LEVEL OF EVIDENCE:

Level III, retrospective comparative series.

PMID:
23520291
DOI:
10.1177/1071100712470914
[Indexed for MEDLINE]
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