Rogero Ryan G, Illical Emmanuel M, Corr Daniel O, Raikin Steven M, Krieg James C, Tsai Justin
Orthopaedic Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, USA.
Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA.
Cureus. 2021 Jul 14;13(7):e16391. doi: 10.7759/cureus.16391. eCollection 2021 Jul.
With no current "gold standard" fixation strategy for syndesmotic injuries and differences in preferred preoperative and intraoperative diagnostic techniques and criteria, methods of reduction, fixation constructs, and postoperative management, the goals of this study were to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption, as well as to identify surgeon demographics predictive of syndesmotic management techniques.
This study was conducted as a web-based survey of foot and ankle fellowship-trained surgeons, Orthopaedic Trauma Association (OTA) members, and Canadian Orthopaedic Association (COA) members. The survey, sent and completed via the HIPAA-compliant Research Electronic Data Capture (REDCap) system, consisted of 18 questions: 6 surgeon demographic questions and 12 specific syndesmotic management questions regarding perioperative protocols and syndesmotic fixation construct techniques.
One hundred and ten orthopaedic surgeons completed our survey. Years of practice and type of fellowship were found to be the variables that influenced perioperative syndesmotic management strategies the most, while a number of fractures operated on per year, country of practice, and practice setting also influenced management decisions. Additionally, 59% (65/110) surgeons indicated that the way they have managed syndesmotic injuries has changed at some point in their career, while 33% (36/110) specified that they could foresee themselves changing their management of these injuries in the future.
There was significant variability among responders in preoperative and intraoperative assessment technique, fixation construct, screw removal protocol, and postoperative weightbearing protocol. This study raises awareness of differences in and factors predictive of management strategies and should be used for further discussion when determining a potential gold standard for the management of these complex injuries.
目前对于下胫腓联合损伤尚无“金标准”固定策略，且在术前和术中诊断技术及标准、复位方法、固定结构和术后处理等方面存在差异。本研究的目的是确定骨科医生目前如何处理合并下胫腓联合损伤的踝关节骨折，以及识别可预测下胫腓联合处理技术的医生人口统计学特征。
本研究通过基于网络的调查开展，对象为接受过足踝专科培训的外科医生、骨科创伤协会（OTA）成员和加拿大骨科协会（COA）成员。该调查通过符合健康保险流通与责任法案（HIPAA）的研究电子数据采集（REDCap）系统发送和完成，包括18个问题：6个关于医生人口统计学的问题和12个关于围手术期方案及下胫腓联合固定结构技术的下胫腓联合处理具体问题。
110名骨科医生完成了我们的调查。发现从业年限和专科培训类型是对围手术期下胫腓联合处理策略影响最大的变量，而每年手术的骨折数量、执业国家和执业环境也影响处理决策。此外，59%（65/110）的医生表示他们处理下胫腓联合损伤的方式在其职业生涯中的某个阶段发生了变化，而33%（36/110）明确表示他们可以预见自己未来会改变对这些损伤的处理方式。
在术前和术中评估技术、固定结构、螺钉取出方案和术后负重方案方面，应答者之间存在显著差异。本研究提高了对处理策略差异及预测因素的认识，在确定这些复杂损伤处理的潜在金标准时，应将其用于进一步讨论。
