T Benzakour, A Hefti, M Lemseffer, A Benzakour (Casablanca, Maroc)
Introduction:
Ankle syndesmotic injuries may be associated to severe trimalleolar fractures. How bad is the prognosis in case of this association, and to which extend it influences the long term follow-up outcome after surgical treatment?
Materials and methods:
98 patients were available for evaluation (follow-up 13.5). Average age is 39.2 years. Weber-A.O. type B: 59 cases including 12 syndesmotic lesions; and type C: 39 cases, with syndesmotic lesions.
Before syndesmosis screwing, our patients had internal fixation of malleoli by screws, wires or plates.
Results:
A scoring system including clinical and radiological exams assesses the outcome of fractures, any instability of syndesmosis and osteo-arthritis.
As far as the syndesmosis could be considered as a virtual forth malleolus because of its apical topography, it seems then logical that it should be also well reduced and fixed. This is related to the significant adequacy found between the initial reduction of the syndesmosis and its late complications such as stability and arthritis.
Global results look quite better in absence of syndesmotic injury.
• Group 1: 47 ankles without syndesmotic lesions: good and very good are (34 =) 72.3%, fair is (10 =) 21.2% and poor is (3 =) 6.4 %
• Group 2: 51 ankles with syndesmotic lesions showing good and very good in (26 =) 51.0%, fair in (14 =) 27.4% and poor in (11 =) 21.6%.
The Khi-Two statistical test is significant since the P-value stands at 0.046 which is lower than 5%.
Conclusions:
• Syndesmotic injuries aggravate trimalleolar ankle fractures and require their accurate reduction and fixation.
• We could then reduce the risks of instability and range of motion loss, and also avoid or delay arthritis changes.