Provincial Specialist Hospital in Legnica, Orthopedic Surgery Department, Iwaszkiewicza 5, 59-220 Legnica, Poland.
Faculty of Health Sciences and Physical Education, The Witelon State University of Applied Sciences in Legnica, Sejmowa 5A, 59-220 Legnica, Poland.
J Foot Ankle Surg. 2024 Nov-Dec;63(6):735-741. doi: 10.1053/j.jfas.2024.07.011. Epub 2024 Aug 2.
The purpose of this study was to assess whether the type and duration of screw fixation affects ankle joint functional scores and patient activity levels. We evaluated 55 patients who had undergone surgical treatment for ankle fracture with concomitant distal tibiofibular syndesmosis injury. The follow-up period ranged from 2 years to 4 years and 2 months (mean 36 months). Depending on the time of screw removal, patients were divided into 2 groups (the 8-15-week group-19 patients, and the 16-22-week group-36 patients). There were 17 patients with tricortical and 38 patients with quadricortical syndesmosis fixation. The following parameters were assessed: range of motion, rates of complications, level of pain in visual analogue scale (VAS), and function. In the quadricortical fixation group the range of plantar flexion p = .04 and adduction p = .043 were significantly lower in the operated than in the nonoperated limb. In the patients who had their syndesmotic screws removed after 16-22 weeks, the range of plantar flexion in the operated limb was significantly lower than that in the nonoperated limb. We observed no differences between the evaluated groups in terms of ankle joint mobility, VAS pain levels, functional outcomes, or complication rates. All the analyzed subgroups showed poorer ranges of some types of motion in the ankle and worse functional scale and VAS pain scores after treatment in comparison with those before the injury. We suggest removing the syndesmotic screws after 8-15 weeks, due to the possibility of earlier rehabilitation, faster return to work and physical activity and less burden on the health care system. Tricortical or quadricortical syndesmosis fixation is at the surgeon's discretion.
本研究旨在评估螺钉固定的类型和时间是否会影响踝关节功能评分和患者的活动水平。我们评估了 55 例因踝关节骨折伴下胫腓联合损伤而接受手术治疗的患者。随访时间为 2 年至 4 年 2 个月（平均 36 个月）。根据螺钉取出的时间，患者分为 2 组（8-15 周组 19 例，16-22 周组 36 例）。17 例患者采用三皮质固定，38 例患者采用四皮质固定。评估的参数包括活动范围、并发症发生率、视觉模拟评分（VAS）疼痛程度和功能。在四皮质固定组中，与非手术侧相比，手术侧的跖屈范围明显更小（p =.04），内收范围也更小（p =.043）。对于那些在 16-22 周后取出下胫腓联合螺钉的患者，手术侧的跖屈范围明显小于非手术侧。在踝关节活动度、VAS 疼痛水平、功能结果或并发症发生率方面，我们未观察到评估组之间存在差异。所有分析的亚组在受伤后治疗的踝关节活动范围、功能评分和 VAS 疼痛评分均较受伤前差。我们建议在 8-15 周后取出下胫腓联合螺钉，因为这可以更早地进行康复治疗，更快地恢复工作和体育活动，减轻医疗保健系统的负担。三皮质或四皮质下胫腓联合固定由术者决定。
