Technique of syndesmotic screw insertion in Weber type C ankle fractures. | [Journal of Surgery Pakistan • 2009]

Author(s):

1. Sajid Ejaz Rao: Department of Orthopaedics, St Mary`s Hospital, Isle of Wight Healthcare NHS Trust, Newport, IOW, PO30 5TG, England, United Kingdom

2. Sohail Muzammil: Department of Orthopaedics, St Mary`s Hospital, Isle of Wight Healthcare NHS Trust, Newport, IOW, PO30 5TG, England, United Kingdom

3. Abdul Hafeez Khan: Combined Military Hospital (CMH), Rawalpindi, Pakistan

Abstract:

Objective To find out impact of the position of the ankle during tightening of the syndesmotic screw used to fix syndesmotic disruption in bimalleolar Weber type C ankle fracture. Study Design A randomised controlled clinical trial. Place & Duration of study Orthopaedic Department at Combined Military Hospital Malir Karachi, from October 2002 to December 2005. Patients and Methods We hypothesized that syndesmotic screw tightening with ankle in plantigrade position rather than 20o dorsiflexion would result in reduced range of dorsiflexion of the ankle joint postoperatively. Twenty-one consecutive young active patients with Weber type C bimalleolar ankle fractures having syndesmotic injuries treated with open reduction and internal fixation were randomly allocated to two groups. In group I (n = 10) syndesmotic screw was inserted with ankle in 20o dorsiflexion and in group II (n = 11) syndesmotic screw was inserted with ankle in plantigrade position. Patients were followed up for 12 months. Study end point was healing of the fracture. Subjective and objective assessment with Olerud-Molander Ankle (OMA) scores and bi-planar radiography was done. The range of ankle dorsiflexion postoperatively, hardware failure and need to remove the screw were the outcome measures. Results Comparing two groups using paired sample t-test, we did not find a statistically significant difference in postoperative range of ankle dorsiflexion between the two groups (p values > 0.05). Differences between the two groups as regard the OMA scores, hardware failure and need to remove the screws were not significant either. Conclusion Syndesmotic screw can be tightened with ankle in plantigrade or dorsiflexed positions without resulting in reduced range of ankle dorsiflexion postoperatively.

Page(s): 58-62

DOI: DOI not available

Published: Journal: Journal of Surgery Pakistan, Volume: 14, Issue: 2, Year: 2009

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