Güngör Erdal, Ercan Niyazi, Ovalı Sancar Alp, Ayduğan Mehmet Yağız, Çetin Hikmet
Department of Orthopaedic and Traumatology, Medipol University Bahçelievler Hospital, İstanbul-Türkiye.
Department of Orthopaedic and Traumatology, Yuksek Ihtisas University Güven Hospital, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Jan;30(12):900-906. doi: 10.14744/tjtes.2024.20094.
Syndesmosis injuries in ankle fractures can significantly impact patient mobility and recovery, making the choice of fixation method crucial for optimal outcomes. This study aimed to compare the quality of reduction and functional results between screw fixation and dynamic fixation in treating syndesmosis injuries in ankle fractures.
This cohort study included 48 patients (28 males, 20 females) with an ankle fracture accompanied by syndesmosis injury. Twenty-four patients were treated with single-level TightRope fixation, while another 24 patients received single 3.5-mm cortical screw fixation. The clinical outcomes were measured using the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Olerud-Molander Ankle Score (OMAS), the Visual Analog Scale (VAS) score, and the Foot and Ankle Disability Index (FADI).
The mean age of the patients was 37.3±15.1 years. The mean follow-up period was 27.6±13.5 months. There were no significant differences between the groups treated with syndesmotic screw or TightRope in terms of the mean postoperative one-year AOFAS score (89.0 and 86.0, respectively), OMAS (84.5 and 85.1, respectively), and FADI (85.4 and 86.8, respectively). The difference between preoperative and postoperative VAS scores was statistically significant (p=0.020). At the first-year follow-up, the median medial clear space was 4.3 mm (range: 2.1 to 5.7 mm) and 4.3 mm (range: 2.3 to 5.7 mm) in the two groups, respectively. The median tibiofibular clear space was 4.8 mm (range: 3.4 to 6.4 mm) in the screw fixation group and 5.1 mm (range: 4.0 to 6.8 mm) in the dynamic fixation group. Meanwhile, the median tibiofibular overlap was 7.8 mm (range: 4.2 to 10.4 mm) and 7.9 mm (range: 4.4 to 10.9 mm) for the screw fixation and dynamic fixation groups, respectively, one year post-surgery.
The dynamic fixation method is as functional as the screw fixation method. Early full weight-bearing and improved pain control were noted as advantages of dynamic fixation compared to screw fixation.
踝关节骨折中的下胫腓联合损伤会显著影响患者的活动能力和恢复情况，因此选择固定方法对于实现最佳治疗效果至关重要。本研究旨在比较螺钉固定和动态固定治疗踝关节骨折中下胫腓联合损伤时的复位质量和功能结果。
本队列研究纳入了48例伴有下胫腓联合损伤的踝关节骨折患者（男性28例，女性20例）。24例患者接受单水平TightRope固定，另外24例患者接受单枚3.5毫米皮质骨螺钉固定。使用美国矫形足踝协会（AOFAS）评分、奥勒鲁德-莫兰德踝关节评分（OMAS）、视觉模拟量表（VAS）评分和足踝功能障碍指数（FADI）来评估临床结果。
患者的平均年龄为37.3±15.1岁。平均随访期为27.6±13.5个月。接受下胫腓联合螺钉或TightRope固定的两组患者在术后一年的平均AOFAS评分（分别为89.0和86.0）、OMAS评分（分别为84.5和85.1）以及FADI评分（分别为85.4和86.8）方面均无显著差异。术前和术后VAS评分的差异具有统计学意义（p = 0.020）。在第一年随访时，两组的内侧间隙中位数分别为4.3毫米（范围：2.1至5.7毫米）和4.3毫米（范围：2.3至5.7毫米）。螺钉固定组的胫腓间隙中位数为4.8毫米（范围：3.4至6.4毫米），动态固定组为5.1毫米（范围：4.0至6.8毫米）。同时，术后一年螺钉固定组和动态固定组的胫腓重叠中位数分别为7.8毫米（范围：4.2至10.4毫米）和7.9毫米（范围：4.4至10.9毫米）。
动态固定方法与螺钉固定方法的功能相当。与螺钉固定相比，可以早期完全负重和更好地控制疼痛是动态固定的优势。
