van den Heuvel Stein B M, Penning Diederick, Halm Jens A, Schepers Tim
Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands.
Trauma Unit, Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
J Foot Ankle Surg. 2025 Jul-Aug;64(4):367-371. doi: 10.1053/j.jfas.2025.01.003. Epub 2025 Jan 11.
Ankle fractures are often accompanied by syndesmotic injuries, contributing to instability and potential long term complications. Syndesmotic injuries are traditionally fixed with either small fragment (3.5-mm diameter) or large fragment (4.5-mm diameter) syndesmotic screws. With regards to the recent emergence of less prominent implants for ankle fracture, this study was set out to compare the outcomes of mini fragment screws (2.7-mm or 2.8-mm diameter) and small fragment screws in syndesmotic fixation. Eighty-seven patients with traumatic syndesmotic injuries were retrospectively included for this study. Forty-four patients underwent mini fragment fixation and 43 patients underwent standard small fragment fixation. After-treatment was similar in both groups. Primary outcome consisted of the incidence of malreduction and secondary dislocation within three months. Secondary objectives were the incidence of the overall complication rate and implant removal rate. In total, malreduction was observed in three patients (3.4 %) and secondary dislocation in two patients (2.3 %), with no significant differences between the mini fragment and small fragment groups. Mini fragment fixation demonstrated a significantly lower overall complication rate (2.3 %) compared to the small fragment group (16.3 %)(p = .030). Implant removal rates were similar between the groups (27.3 % for mini fragment and 27.9 % for small fragment screws). This study suggests that both screw types are effective for fixation of acute syndesmotic injuries, with comparable malreduction and secondary dislocation rates. Prospective studies with longer follow-up, including functional outcome, are needed for comprehensive insights into optimal syndesmotic screw selection.
踝关节骨折常伴有下胫腓联合损伤，可导致关节不稳定及潜在的长期并发症。传统上，下胫腓联合损伤采用小直径（3.5毫米）或大直径（4.5毫米）的下胫腓联合螺钉固定。鉴于近期用于踝关节骨折的植入物不太突出，本研究旨在比较微型螺钉（直径2.7毫米或2.8毫米）和小直径螺钉在下胫腓联合固定中的效果。本研究回顾性纳入了87例创伤性下胫腓联合损伤患者。44例患者接受微型螺钉固定，43例患者接受标准小直径螺钉固定。两组的术后治疗相似。主要结局包括三个月内复位不良和继发性脱位的发生率。次要目标是总体并发症发生率和植入物取出率。总共观察到3例患者（3.4%）出现复位不良，2例患者（2.3%）出现继发性脱位，微型螺钉组和小直径螺钉组之间无显著差异。与小直径螺钉组（16.3%）相比，微型螺钉固定的总体并发症发生率显著较低（2.3%）（p = 0.030）。两组的植入物取出率相似（微型螺钉为27.3%，小直径螺钉为27.9%）。本研究表明，两种类型的螺钉在急性下胫腓联合损伤的固定中均有效，复位不良和继发性脱位率相当。需要进行更长时间随访的前瞻性研究，包括功能结局，以全面了解下胫腓联合螺钉的最佳选择。
