On-line version ISSN 2309-8309
SA orthop. j. vol.8 n.1 Pretoria Jan. 2009
J Chris CoetzeeI; Patrick B EbelingII
IMD, MMed Ortho; Minnesota Sports Medicine & Twin Cities Orthopedics; Adjunct Associate Professor, University of Minnesota, Minneapolis
IIMD; Minnesota Sports Medicine & Twin Cities Orthopedics; Adjunct Associate Professor, University of Minnesota, Minneapolis
BACKGROUND: Open reduction and screw fixation is the current standard treatment for displaced injuries of the ankle syndesmosis. Despite reduction and stable internal fixation, however, these injuries do not uniformly have excellent outcomes. In addition, screw fixation has potential disadvantages.
MATERIALS AND METHODS: An ongoing prospective, randomized clinical trial comparing conventional screw fixation with TightRope® fiber wire fixation for syndesmosis injuries. The objective of this paper is also to provide an overview of the important anatomical and biomechanical issues relating to syndesmosis injuries.
RESULTS: At medium term follow-up the TightRope® fiber wire fixation group had a statistically significant better range of motion compared to conventional screw fixation. The AOFAS ankle and hindfoot score did not show a significant difference between the two groups.
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1. Tornetta P, Spoo JE, Reynolds FA, Lee C. Overtightening of the ankle syndesmosis: Is it really possible? J Bone Joint Surg (Am) 2001;83-A:489-92. [ Links ]
2. McBryde A, Chiasson B, Wilhelm A, Donovan F, Ray T, Bacilla P. Syndesmotic screw placement: A biomechanical analysis. Foot Ankle Int 1997;18:262-6. [ Links ]
3. Hoiness P, Stromsoe K. Tricortical versus quadricortical syndesmosis fixation in ankle fractures. A prospective, randomized study comparing two methods of syndesmosis fixation. J Orthop Trauma 2004;18:331-7. [ Links ]
4. Beumer A, Campo MM, Niesing R, Day J, Kleinrensink G-J, Swierstra BA. Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation. Injury Int J Care Injured 2005;36:60-4. [ Links ]
5. Lundberg A. Kinematics of the ankle and foot - in vivo roentgen stereophotogrammetry. Acta Orthop Scand Suppl 1989;223:1-24. [ Links ]
6. Beumer A, Valstar ER, Garling EH, Niesling R, Ranstam J, Lofvenberg R, Swierstra BA. Kinematics of the distal tibiofibular syndesmosis. Radiostereometry in 11 normal ankles. Acta Orthop Scand 2003;74:337-43. [ Links ]
7. Ogilvie-Harris DJ, Reed SC, Hedman TP. Disruption of the ankle syndesmosis: Biomechanical study of the ligamentous restraints. Arthroscopy 1994;10:558-60. [ Links ]
8. Lloyd J, Elsayed S, Hariharan K, Tanaka H. Revisiting the concept of talar shift in ankle fractures. Foot Ankle Int 2006 Oct; 27(10):793-6. [ Links ]
9. Taser F, Shafiq Q, Ebraheim NA. Three-dimensional volume rendering of tibiofibular joint space and quantitative analysis of change in volume due to tibiofibular syndesmosis diastases. Skeletal Radiol 2006 Dec;35(12):935-41. Epub 2006 Mar 15. [ Links ]
10. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int 2006 Oct;27(10):788-92. [ Links ]
11. Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Ortho Trauma 2005;19:102-8. [ Links ]
12. Pereira DS, Koval KJ, Resnick RB, Sheskier SC, Kummer F, Zuckerman JD. Tibiotalar contact area and pressure distribution: The effect of mortise widening and syndesmosis fixation. Foot Ankle Int 1996;17:269-74. [ Links ]
13. Miller R, Weinhold P, Dahners L. Comparison of tricortical screw fixation versus a modified suture construct for fixation of ankle syndesmosis injury: A biomechanical study. J Orthro Trauma 1999;13:39-42. [ Links ]
14. Forsythe K, Freedman K, Stover M, Patwardhan A. Comparison of a novel fiberwire-button construct versus metallic screw fixation in a syndesmotic injury model. Foot Ankle Int 2008;29:49-54. [ Links ]
15. Thornes B, Shannon F, Guiney A, Hession P, Masterson E. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop 2005;431:207-12. [ Links ]
Dr J Chris Coetzee
Minnesota Sports Medicine & Twin Cities Orthopedics
775 Prairie Center Drive #250
Eden Prairie, MN 55344
Tel: 952 944 2519; Fax: 952 944 0460
This article was submitted to an ethical committee for approval. The content of this article is the sole work of the authors. No benefits of any form have been derived from any commercial party related directly or indirectly to the subject of this article.