Fri., 10/19/07 Foot & Ankle, Paper #33, 3:21 pm OTA-2007
Outcome after Unstable Ankle Fracture: Effect of Syndesmotic Stabilization
Kenneth A. Egol, MD (a-Synthes, Stryker, Biomet, Smith+Nephew);
Michael Walsh, PhD (n); Nirmal C. Tejwani, MD (e-Stryker, Biomet);
Kenneth J. Koval, MD (e-Biomet, Stryker);
NYU Hospital for Joint Diseases, New York, New York, USA
Purpose: Controversy exists regarding fixation choices in patients who have sustained a syndesmotic ankle injury. Little information, however, is known on clinical outcomes following such injuries. The purpose of this study was to evaluate the results of operative treatment of ankle fractures in patients who required syndesmotic stabilization in addition to malleolar fracture fixation compared to those who required malleolar fixation alone.
Methods: Between October 2000 and November 2006, 488 patients who underwent surgical repair of an unstable ankle fracture were enrolled in a prospective database. Baseline functional status was obtained at time of injury. Patients who had an associated syndesmotic disruption requiring surgical stabilization in association with either an ankle fracture or a fracture dislocation were identified and compared to a cohort treated during the same time period who sustained an ankle fracture or fracture dislocation without syndesmotic stabilization. No syndesmotic screws were removed routinely. All patients were followed and evaluated at 3, 6, 12, and 24 months with clinical and radiographic examination as well as functional status (SMFA, AOFAS). Standard statistical analysis was performed comparing final outcome to baseline.
Results: 376 patients (77%) met the inclusion criteria and minimum 1-year follow-up. 92 (24%) who had syndesmotic stabilization were identified and compared to 284 patients (76%) who did not. No differences were found between the two groups with respect to gender or ASA status. There were a greater percentage of men in the syndesmotic injury group (P = 0.04) There was a clear difference in outcome based on AOFAS and SMFA scores at 12 months. Patients who underwent syndesmotic stabilization had worse AOFAS scores at 1 year with lower function ratings (P = 0.02). SMFA scores were also worse at 12 months in patients who had syndesmotic stabilization. Both the bother (P = 0.03) and the dysfunction (P = 0.009) indexes were higher in the syndesmotic group. Radiographically, all fractures united. There were two delayed fibular unions in the syndesmotic group. 20 syndesmotic screws were noted to be broken on follow up radiographs, 8 of which were subsequently removed. There were no differences in complication rates.
Conclusion: Patients who require syndesmotic stabilization in addition to an ankle fracture fixation have poorer outcomes at 12 months when compared to patients who require ankle fracture fixation alone. This information is important for patient counseling in order to manage expectations regarding outcomes after injury.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.