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Dynamic fixation may offer better clinical, radiographic results than static fixation
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Recently published data indicted utilizing a dynamic device for fixation of an acute syndesmosis rupture appeared to result in better clinical and radiographical outcomes compared with conventional screw fixation, offering syndesmotic stabilization without failure or loss of reduction and lower reoperation rates.
The multicenter, randomized, double-blind, controlled trial included 70 patients admitted for an acute syndesmosis rupture who randomly assigned to one of two treatment groups: 34 patients underwent dynamic fixation, and 36 patients underwent static fixation. Of the patients initially included, 65 completed the study and had data available for analysis.
A 3.5-mm cortical screw was used in the static group for syndesmosis fixation and one TightRope implant (Anthrex) was used in the dynamic group. Rehabilitation was standard for both groups, during which patients wore a cast for 6 weeks without weight bearing and then underwent rehabilitation without protection, according to the researchers.
The study’s primary outcome measure was patients’ Olerud-Molander (OM) score. At 3 months, 6 months and 12 months, the OM score was recorded and clinical evaluations were conducted. The researchers also used the American Orthopaedic Foot and Ankle Society (AOFAS) score to assess clinical performance. Additionally, radiographs were taken after surgery and at all follow-up visits.
Results showed the dynamic fixation group performed better at each follow-up compared with the static fixation group with regard to OM scores. At the 6-month follow-up, more patients in the dynamic fixation group achieved excellent functional results. Although patients in each treatment group achieved good-to-excellent results by the 12-month follow-up, scores increased more quickly and were higher in the dynamic fixation group, according to the researchers.
With regard to plantar flexion, ankle range of motion was higher in the dynamic flexion group than in static fixation group; however, this difference was considered minor with regard to dorsal flexion.
AOFAS scores were higher at the 3-month follow-up for each group (78.6 vs. 70.6) than the 6-month follow-up (87.1 vs. 83.8) and 12-month follow-up (93.1 vs. 89.9), with only the between-group difference at 3 months considered statistically significant. However, the static group had a higher rate of implant failure, and four patients had a loss of reduction compared with no patients in the dynamic group.
Both groups achieved adequate reduction at surgery, and only one patient required corrective surgery, according to the researchers. – by Monica Jaramillo
Disclosures: Laflamme reports she receives institutional support from DePuy Synthes, Stryker, MSSS, the Canadian Institutes of Health Research (CIHR), and by a training program from CIHR. Please see the full study for a list of all other authors’ financial disclosures.
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