Hadley Steven M, Bergman Rachel, Peabody John J, Westvold Sarah J, Filler Ryan, Mutawakkil Muhammad, Patel Milap, Kadakia Anish R
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Orthop Surg Res. 2025 Aug 6;20(1):730. doi: 10.1186/s13018-025-06137-9.
It remains unclear whether syndesmotic fixation technique impacts outcomes following ankle fracture surgery. This study investigates which repair technique, transyndesmotic screws, Suture Button (SB), and suture tape augmentation (STA), results in fewest complications and best functional outcomes measured by Patient Reported Outcome Measurement Information System (PROMIS) computerized adaptive tests (CATs) of physical function (PF) and pain interference (PI).
782 patients who underwent ankle fracture surgery at a single institution between 2016 and 2021 were retrospectively reviewed. Two fellowship-trained orthopaedic surgeons independently reviewed all radiographs, determined fixation technique, and assessed complications. Open fractures, pilons, and neuropathies were excluded. 252 had syndesmotic injury identified via intraoperative fluoroscopy. 159/252 who had minimum one-year radiographic follow-up were included for complications analysis. These 159 were sent post-operative PROMIS CATs. 68/159 consented and were included for final analysis of PROMIS. Kruskal-Wallis test compared PROMIS across repair types. Multinomial logistic regression adjusted for propensity scores included as covariates modeled PROMIS by technique.
62/159 had screw, 59/159 SB, and 38/159 STA. Screw complication rate was 12.9% (8/62): 8.1% (5/62) degenerative joint disease (DJD), 6.5% (4/62) syndesmotic malreduction. SB complication rate was 1.7% (1/59): 1.7% (1/59) DJD. STA had no radiographic complications. Mean PF was 50.5 ± 7.9 screw, 53.9 ± 9.7 SB, and 52.2 ± 13.1 STA (p = 0.72). Mean PI was 49.6 ± 8.2 screw, 47.9 ± 8.8 SB, and 49.2 ± 10.5 STA (p = 0.75). Mean PF was 5.1-points (95%CI: -0.9-11.1) higher for SB and 5.2-points (95%CI: -1.3-11.7) greater for STA vs. screw. Mean PI was 3.2-points less for SB (-3.2, 95%CI:-8.5-2.1) and 4.4-points less for STA (-4.4, 95%CI: -10.1-1.3) vs. screws.
Syndesmotic fixation with either SB or STA reduces complications compared to screw. While this study was underpowered to detect differences in PROMIS, improved PROMIS for SB and STA vs. screws suggest that these techniques may result in better functional outcomes compared to screws.
目前尚不清楚下胫腓联合固定技术是否会影响踝关节骨折手术后的疗效。本研究调查了哪种修复技术，即经下胫腓螺钉、缝线纽扣（SB）和缝线带增强术（STA），导致的并发症最少，以及通过患者报告结局测量信息系统（PROMIS）的身体功能（PF）和疼痛干扰（PI）计算机自适应测试（CAT）所测量的功能结局最佳。
回顾性分析了2016年至2021年间在单一机构接受踝关节骨折手术的782例患者。两名经过专科培训的骨科医生独立复查所有X线片，确定固定技术并评估并发症。开放性骨折、pilon骨折和神经病变被排除在外。通过术中透视确定252例存在下胫腓联合损伤。对其中159例进行了至少一年的影像学随访的患者进行并发症分析。这159例患者被发送了术后PROMIS CAT。159例中有68例同意并被纳入PROMIS的最终分析。采用Kruskal-Wallis检验比较不同修复类型的PROMIS。多因素逻辑回归对作为协变量纳入的倾向得分进行调整，按技术对PROMIS进行建模。
159例中，62例采用螺钉固定，59例采用SB固定，38例采用STA固定。螺钉固定的并发症发生率为12.9%（8/62）：8.1%（5/62）为退行性关节病（DJD），6.5%（4/62）为下胫腓联合复位不良。SB固定的并发症发生率为1.7%（1/59）：1.7%（1/59）为DJD。STA固定无影像学并发症。螺钉固定组的平均PF为50.5±7.9，SB固定组为53.9±9.7，STA固定组为52.2±13.1（p = 0.72）。螺钉固定组的平均PI为值49.6±8.2，SB固定组为47.9±8.8，STA固定组为49.2±10.5（p = 0.75）。与螺钉固定相比，SB固定组的平均PF高5.1分（95%CI：-0.9至11.1），STA固定组高5.2分（95%CI：-1.3至11.7）。与螺钉固定相比，SB固定组的平均PI低3.2分（-3.2，95%CI：-8.5至2.1），STA固定组低4.4分（-4.4，95%CI：-10.1至1.3）。
与螺钉固定相比，采用SB或STA进行下胫腓联合固定可减少并发症。虽然本研究检测PROMIS差异的效能不足，但与螺钉固定相比，SB和STA的PROMIS改善表明这些技术可能会带来更好的功能结局。
