Flexible fixation may reduce rate of syndesmotic malreduction, functional impairment
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Compared with rigid fixation, flexible fixation after syndesmotic injury better restored physiologic motion and reduced rates of syndesmotic malreduction, according to recently presented results.
“Traditionally, rigid fixation with one or more syndesmotic screws fixed the fibula directly to the tibia though flexible devices have been introduced, which are made of a heavy suture secured through a track through the fibula and tibia with an endobutton,” Murray T. Wong said in his presentation at the Orthopaedic Research Society Annual Meeting.
To compare the syndesmotic kinematics following the two techniques, Wong and colleagues from the University of Calgary analyzed 4D CT scans of 13 patients who were randomly assigned to either rigid (n = 7) or flexible (n = 6) fixation.
At the time of imaging, Wong and colleagues found cases of broken, loose or removed screws in all seven patients who received rigid fixation. Comparatively, flexible fixation maintained syndesmotic reduction in all six patients, according to the study.
Researchers also noted that despite the loss of fixation in the rigid fixation cases, the fixation led to reduced physiologic motion in middle syndesmosis distance, posterior syndesmosis distance, tibiofibular clear space and tibiofibular overlap. However, no differences were detected between the flexible fixation cohort and uninjured ankles.
“These results challenged the common notion that allowing rigid fixation to fail or removing implants serves to restore motion and allays concerns that flexible fixation cannot adequately constrain the syndesmosis,” Wong said. “So, by applying these findings to clinical practice, we hope to decrease the rate of syndesmotic malreduction and reduced functional impairment after injury.”
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Wong MT, et al. Podium presentation 0150. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 12-16, 2021 (virtual meeting).
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