Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Injury. 2012 Oct;43(10):1718-23. doi: 10.1016/j.injury.2012.06.015. Epub 2012 Jul 15.
Ankle fractures are one of the most frequently encountered musculoskeletal injuries, and 10% of patients have a concomitant distal tibiofibular syndesmotic disruption necessitating surgical repair. A national survey was conducted to gain more insight into the current approaches in the management of syndesmotic injuries in the Netherlands.
A postal survey was sent to one or two staff members of the trauma and orthopaedic surgery departments in each of the 86 hospitals in the Netherlands. Questions concerned the pre-, per- and postoperative strategies and the different ideas on the type, number and placement of the syndesmotic screw.
A total of 85.2% of the trauma surgeons and 61.9% of the orthopaedic surgeons responded (representing 87% of all hospitals). Syndesmotic injury was judged mainly using the 'Hook test'. Syndesmotic injuries in a Weber-B ankle fracture were treated with one screw in 81.2% of cases and in Maisonneuve injuries mainly with two screws. The 3.5-mm screw was used most frequently over three cortices at 2.1-4.0cm above the tibial plafond. Removal of the syndesmotic screw was routinely done by 87.0% of surgeons, mostly between 6 and 8 weeks. Of all respondents, 62.3% showed interest in participating in a randomised controlled trial comparing standard removal with removal on indication.
Compared with previous surveys our survey is more complete, has the highest response rate and has almost national coverage. Most individual items reviewed compare well with current literature, except for the routine removal of the syndesmotic screw, which might not be encouraged from a literature point of view. For this reason, the results of the current survey will be used in the development of a multicentre randomised controlled trial comparing the functional outcome in routine removal of the syndesmotic screw compared with removal on indication.
踝关节骨折是最常见的肌肉骨骼损伤之一，10%的患者伴有下胫腓联合远端的分离性损伤，需要手术修复。进行了一项全国性调查，以更深入地了解荷兰在治疗下胫腓联合损伤方面的当前方法。
向荷兰 86 家医院的每家创伤和骨科外科的一到两名工作人员发送了一份邮寄调查。问题涉及术前、术中和术后的策略，以及对下胫腓联合螺钉类型、数量和位置的不同看法。
85.2%的创伤外科医生和 61.9%的矫形外科医生（代表所有医院的 87%）做出了回应。“钩试验”主要用于判断下胫腓联合损伤。韦伯-B 型踝关节骨折中的下胫腓联合损伤在 81.2%的病例中用 1 颗螺钉治疗，而 Maisonneuve 损伤主要用 2 颗螺钉治疗。最常用的是 3.5 毫米螺钉，在距胫骨平台上方 2.1-4.0 厘米处穿过三个皮质。87.0%的外科医生常规取出下胫腓联合螺钉，大多在 6-8 周之间。所有受访者中，62.3%表示有兴趣参加一项比较标准取出与指征性取出的随机对照试验。
与之前的调查相比，我们的调查更全面，回复率最高，几乎涵盖了全国范围。除了常规取出下胫腓联合螺钉这一项，这可能不符合文献观点，除了这一项，审查的大多数单项都与当前文献相符。出于这个原因，当前调查的结果将用于开发一项多中心随机对照试验，比较常规取出与指征性取出在下胫腓联合螺钉的功能结果方面的差异。
