Department of Orthopaedic Surgery, University of Nevada, Las Vegas, Las Vegas, NV.
San Diego Medical Center, University of California.
J Pediatr Orthop. 2021 Jul 1;41(6):e427-e432. doi: 10.1097/BPO.0000000000001803.
Fixation of the tibiofibular syndesmosis is often performed with a trans-syndesmotic screw (SS) or suture-button (SB). SB fixation has been shown to have lower rates of postoperative syndesmotic malreduction, late diastasis, and implant removal, though some studies have found complications related to infection and implant subsidence. The purpose of this study was to compare maintenance of reduction, complications, implant removal and functional outcomes of SB versus SS fixation in adolescents.
A retrospective chart review identified patients who underwent syndesmotic fixation from 2010 to 2019 at a single institution. Loss of syndesmotic reduction (diastasis) was defined as either a >2 mm increase in tibiofibular clear space or >2 mm decrease in tibiofibular overlap, and corresponding incongruence of the ankle mortise (medial clear space 1 millimeter greater than superior clear space). Functional outcomes were collected at a minimum of 1 year postsurgery using the Foot and Ankle Ability Measure (FAAM).
Seventy-seven adolescents (45 SS, 32 SB) were included (mean age: 16±1.5 y). Forty-five patients had Weber C fibula fractures, 27 Weber B fractures, and 5 had isolated syndesmotic injuries or small posterior malleolus fractures. Fifty-one patients (66%) had functional outcomes available. There was no significant difference in mean FAAM Sports score between the 2 groups (SB=94.8%, SS=89.8%) at mean follow-up of 4.0±2.1 years. Syndesmotic implant removal occurred in 36/45 patients (80%) in the SS group compared with 4/32 patients (13%) in the SB group. There was 1 case of syndesmotic malreduction requiring revision surgery in the SS group, and no cases of postoperative malreduction or diastasis in the SB group. Nine patients in the SB group and 8 in the SS group weighed over 100 kilograms, with no cases of diastasis in these larger patients. There were 4 superficial infections and 1 deep infection in the screw group, with 1 superficial infection in the SB group.
While both SB and screw fixation maintained syndesmotic reduction, SB fixation led to lower rates of implant removal surgery. SB fixation was equally effective at preventing recurrent diastasis in adolescents weighing over 100 kilograms, and functional outcomes were at least equivalent to screw-fixation at mean follow-up of 4.0 years.
Level III.
胫腓联合的固定通常采用经联合螺钉（SS）或缝线纽扣（SB）固定。尽管一些研究发现与感染和植入物下沉有关的并发症，但 SB 固定已显示出术后联合复位不良、晚期分离和植入物去除率较低。本研究的目的是比较青少年 SB 与 SS 固定后维持复位、并发症、植入物去除和功能结果。
回顾性图表审查确定了 2010 年至 2019 年在一家机构接受联合固定的患者。联合复位丢失（分离）定义为胫腓骨间隙增加>2mm 或胫腓骨重叠减少>2mm，以及相应的踝穴不吻合（内侧间隙比上侧间隙大 1 毫米）。术后至少 1 年采用足踝能力测量（FAAM）收集功能结果。
77 名青少年（45 名 SS，32 名 SB）入选（平均年龄：16±1.5y）。45 例患者有 Weber C 腓骨骨折，27 例 Weber B 骨折，5 例有单纯联合损伤或小后踝骨折。51 例患者（66%）有功能结果。在平均 4.0±2.1 年的随访中，两组的 FAAM 运动评分无显著差异（SB=94.8%，SS=89.8%）。在 SS 组中，36/45 例（80%）发生联合植入物去除，而在 SB 组中，4/32 例（13%）发生联合植入物去除。SS 组有 1 例联合复位不良需行翻修手术，SB 组无术后复位不良或分离。SB 组 9 例和 SS 组 8 例患者体重超过 100 公斤，这些较大患者中无分离病例。在螺钉组中有 4 例浅表感染和 1 例深部感染，在 SB 组中有 1 例浅表感染。
尽管 SB 和螺钉固定均能维持联合复位，但 SB 固定导致植入物去除手术的发生率较低。在体重超过 100 公斤的青少年中，SB 固定同样能有效预防再分离，在平均 4.0 年的随访中，功能结果至少与螺钉固定相当。
III 级。
