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Syndesmosis transfixation did not improve outcomes of Weber B fractures significantly
Patients who did not undergo syndesmotic fixation also saw improved pain and function scores.
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Patients with supination-external rotation ankle fractures, called Weber B-type fractures, who were not treated with syndesmotic fixation attained good functional results, according to results of a prospective study. The patients also had no increased incidence of osteoarthritis and experienced less pain than patients who underwent syndesmosis screw fixation for the same injury.
In all, 140 patients with supination-external rotation ankle fractures underwent surgery and were included in a prospective study that analyzed their outcomes at a mid-term follow-up. Tero Kortekangas, MD, presented the results at a meeting.
“Our results showed constant improvement in functional results in the non-syndesmotic group within the follow-up time,” Kortekangas said. “Syndesmotic fixation did not influence the functional results or radiological findings after a minimum of 4 years of follow-up compared to no syndesmotic fixation.”
Does fixation result in better outcomes?
Among the patients studied, 116 patients had a stable syndesmosis after bony fixation. Of the 24 patients whose syndesmosis was unstable vs. the uninjured side, 13 patients were randomized to undergo syndesmotic screw fixation and 11 patients were randomized for no syndesmotic fixation.
A positive stress examination was defined as a difference of greater than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs, according to Kortekangas.
The investigators, who are from Oulu University Hospital, in Oulu, Finland, assessed ankle joint congruity and osteoarthritis using mortise and lateral projection plain weight-bearing radiographs and 3T MRI scans.
VAS, Olerud-Molander scores
After 4 years minimum follow-up (mean of 58 months), the investigators assessed results of the Olerud-Molander score, the 100-mm VAS score for ankle function and pain and quality of life based on the RAND-36 score. The length of follow-up did not correlate to the patient-related outcomes, Kortekangas said.
“During the follow-up, in the no syndesmotic fixation group, there was significant improvement in the Olerud-Molander score and pain score, whereas no improvement in either functional scores for the syndesmotic fixation group was observed,” he said.
The no fixation syndesmotic group demonstrated an average improvement of 11 points for the Olerud-Molander score and the VAS pain scores improved from 11 points to 4 points (P = 0.038) from 1 postoperative year to the final follow-up, according to the results.
The results also showed there was no significant postoperative difference in osteoarthritis rates in either group.
“No severe findings of postoperative osteoarthritis or significance between both groups were detected. However, 12 patients had joint cartilage defects visible in the MRI — eight in the syndesmotic fixation group to four in the no syndesmotic group,” Kortekangas said. – by Robert Linnehan
- Reference:
- Kortekangas T, et al. Paper #35. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 16-18, 2014; Tampa, Fla., USA.
- For more information:
- Tero Heikki Juhana Kortekangas, MD, can be reached at the Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland; email: tero.kortekangas@ppshp.fi.
Disclosure: Kortekangas reports no relevant financial disclosures.