Department of Orthopedics Trauma, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China.
Department of Arthroplasty Surgery, 80th Army Group Hospital of People's Liberty Army, Wei Fang, P.R. China.
J Foot Ankle Surg. 2022 Jan-Feb;61(1):143-148. doi: 10.1053/j.jfas.2021.07.009. Epub 2021 Jul 20.
Twenty percent of ankle fractures present with concomitant syndesmosis injury which results in poor clinical outcomes. Surgical stabilization of the syndesmosis can be achieved with either trans-syndesmotic screws or a suture button device. The aim of this study is to investigate the clinical efficacy of suture button fixation and trans-syndesmotic screw fixation in the treatment of ankle fracture combined with distal tibiofibular syndesmosis injury. A retrospective analysis was conducted by enrolling 76 patients with ankle fractures combined with distal tibiofibular syndesmosis injury who were admitted in our trauma center from January 2018 to January 2019, including 34 cases of suture button group and 42 cases of the syndesmotic screw group with a mean follow-up period of 16 ± 7 (range 12-21) months. The demographic data included gender, age, injury mechanism, AO classification and the operation duration were recorded, the radiographic and clinical outcomes were determined by tibiofibular clear space, tibiofibular overlap distance, complications, and the Olerud-Molander Ankle Score at the last follow-up. All the indexes were compared between the 2 groups to discover the related statistical differences. With the numbers available, no significant difference could be detected in the surgical duration, tibiofibular clear space, tibiofibular overlap distance, total complication rate, and middle-term Olerud-Molander Ankle scores between the 2 groups. However, the suture button fixation group showed higher early stage Olerud-Molander Ankle scores (p = .027) and shorter full weightbearing time (p = .018) than that of syndesmotic screw fixation group. Considering the outcomes, we conclude that the suture button fixation not only shows equivalent efficacy to the traditional syndesmotic screw, but also has advantages of allowing early weightbearing, low requirements for routine removal.
20%的踝关节骨折合并下胫腓联合损伤，临床疗效不佳。下胫腓联合损伤可采用经皮螺钉或缝线纽扣固定。本研究旨在探讨缝线纽扣固定与经皮螺钉固定治疗踝关节骨折合并下胫腓联合损伤的临床疗效。回顾性分析 2018 年 1 月至 2019 年 1 月在我院创伤中心治疗的 76 例踝关节骨折合并下胫腓联合损伤患者，其中缝线纽扣组 34 例，经皮螺钉组 42 例，平均随访 16±7（12-21）个月。记录患者性别、年龄、损伤机制、AO 分型及手术时间，采用胫腓骨间隙、胫腓骨重叠距离、并发症及末次随访时 Olerud-Molander 踝关节评分评估影像学和临床疗效。比较两组患者各项指标，发现统计学差异。根据现有的数据，两组患者的手术时间、胫腓骨间隙、胫腓骨重叠距离、总并发症发生率及中期 Olerud-Molander 踝关节评分无统计学差异。然而，缝线纽扣固定组的早期 Olerud-Molander 踝关节评分（p=0.027）和完全负重时间（p=0.018）均高于经皮螺钉固定组。考虑到这些结果，我们得出结论，缝线纽扣固定不仅与传统的经皮螺钉固定具有等效疗效，而且还具有允许早期负重、对常规取出要求低的优点。
