Syndesmotic disruption occurs in more than 10% of ankle fractures. Operative treatment with syndesmosis screw fixation has been successfully performed for decades and is considered the gold standard of treatment. Few studies have reported the long-term outcomes of syndesmosis injuries. This study investigated long-term patient-reported, radiographic, and functional outcomes of syndesmosis injuries treated with screw fixation and subsequent timed screw removal. A retrospective cohort study was carried out at a Level I trauma center. The study group included 43 patients who were treated for ankle fractures with associated syndesmotic disruptions between December 2001 and May 2011. The study included case file reviews, self-reported questionnaires, radiologic reviews, and clinical assessments. At 5.1 (±1.76) years after injury, 60% of participants had pain, 26% had degenerative changes, 51% had loss of tibiofibular overlap, and 33% showed medial clear space widening. Retained syndesmotic positions on radiographs were linked to better self-reported outcomes. There is an inversely proportional relation between age at the time of injury and satisfaction with the outcome of the ankle fracture as well as a directly proportional relation between age at the time of injury and pain compared with the preinjury state. Optimal restoration and preservation of the syndesmosis is crucial. Syndesmotic disruption is associated with poor long-term outcomes after ankle fracture. Greater age is a risk factor for chronic pain and dissatisfaction with the outcome of ankle fracture and syndesmosis injury. Therefore, patient education to facilitate realistic expectations about recovery is vital, especially in older patients. [Orthopedics. 2015; 38(11):e1001–e1006.]
- 1.van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001; 29(6):517–522.
10.1016/S8756-3282(01)00614-7Crossref, Google Scholar
- 2.Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures: an increasing problem?Acta Orthop Scand. 1998; 69(1):43–47.
10.3109/17453679809002355Crossref, Google Scholar
- 3.Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. 2006; 36(6):372–384.
10.2519/jospt.2006.2195Crossref, Google Scholar
- 4.Schepers T. To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg. 2011; 131(7):879–883.
10.1007/s00402-010-1225-xCrossref, Google Scholar
- 5.Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. 2012; 26(7):439–443.
10.1097/BOT.0b013e31822a526aCrossref, Google Scholar
- 6.Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma. 2005; 19(2):102–108.
10.1097/00005131-200502000-00006Crossref, Google Scholar
- 7.Tunturi T, Kemppainen K, Pätiälä H, Suokas M, Tamminen O, Rokkanen P. Importance of anatomical reduction for subjective recovery after ankle fracture. Acta Orthop Scand. 1983; 54(4):641–647.
10.3109/17453678308992903Crossref, Google Scholar
- 8.Dattani R, Patnaik S, Kantak A, Srikanth B, Selvan TP. Injuries to the tibiofibular syndesmosis. J Bone Joint Surg Br. 2008; 90(4):405–410.
10.1302/0301-620X.90B4.19750Crossref, Google Scholar
- 9.Tornetta P, Spoo JE, Reynolds FA, Lee C. Overtightening of the ankle syndesmosis: is it really possible?J Bone Joint Surg Am. 2001; 83(4):489–492. Google Scholar
- 10.Qamar F, Kadakia A, Venkateswaran B. An anatomical way of treating ankle syndesmotic injuries. J Foot Ankle Surg. 2011; 50(6):762–765.
10.1053/j.jfas.2011.07.001Crossref, Google Scholar
- 11.Roos EM, Brandsson S, Karlsson J. Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int. 2001; 22(10):788–794. Google Scholar
- 12.Wikerøy AK, Høiness PR, Andreassen GS, Hellund JC, Madsen JE. No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures. J Orthop Trauma. 2010; 24(1):17–23.
10.1097/BOT.0b013e3181bedca1Crossref, Google Scholar
- 13.Hsu YT, Wu CC, Lee WC, Fan KF, Tseng IC, Lee PC. Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function. Int Orthop. 2011; 35(3):359–364.
10.1007/s00264-010-1147-9Crossref, Google Scholar
- 14.Pakarinen H. Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury. Acta Orthop Suppl. 2012; 83(347):1–26.
10.3109/17453674.2012.745657Crossref, Google Scholar
- 15.Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012; 40(12):2828–2835.
10.1177/0363546512461480Crossref, Google Scholar
- 16.Tatro-Adams D, McGann SF, Carbone W. Reliability of the figure-of-eight method of ankle measurement. J Orthop Sports Phys Ther. 1995; 22(4):161–163.
10.2519/jospt.19188.8.131.52Crossref, Google Scholar
- 17.Mawdsley R, Hoy DK, Erwin PM. Criterion-related validity of the figure-of-eight method of measuring ankle edema. J Orthop Sports Phys Ther. 2000; 30(3):148–153.
10.2519/jospt.2000.30.3.149Crossref, Google Scholar
- 18.Roos E. Knee injury and osteoarthritis outcome score. http://koos.nu/index.html. Accessed July 29, 2013. Google Scholar
- 19.EuroQolGroup. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16(3):199–208.
10.1016/0168-8510(90)90421-9Crossref, Google Scholar
- 20.Brooks R. EuroQol: the current state of play. Health Policy. 1996; 37(1):53–72.
10.1016/0168-8510(96)00822-6Crossref, Google Scholar
- 21.Herdman M, Gudex C, Lloyd A, Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011; 20(10):1727–1736.
10.1007/s11136-011-9903-xCrossref, Google Scholar
- 22.Janssen MF, Pickard AS, Golicki D, Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013; 22(7):1717–1727.
10.1007/s11136-012-0322-4Crossref, Google Scholar
- 23., eds. Measuring Self-Reported Population Health: An International Perspective Based on EQ-5D. Rotterdam, The Netherlands: EuroQol Group; 2004. Google Scholar
- 24.Chissell HR, Jones J. The influence of a diastasis screw on the outcome of Weber type-C ankle fractures. J Bone Joint Surg Br. 1995; 77(3):435–438. Google Scholar
- 25.Kennedy JG, Soffe KE, Dalla Vedova P, Evaluation of the syndesmotic screw in low Weber C ankle fractures. J Orthop Trauma. 2000; 14(5):359–366.
10.1097/00005131-200006000-00010Crossref, Google Scholar
- 26.Daley MJ, Spinks WL. Exercise, mobility and aging. Sports Med. 2000; 29(1):1–12.
10.2165/00007256-200029010-00001Crossref, Google Scholar
- 27.Tucker A, Street J, Kealey D, McDonald S, Stevenson M. Functional outcomes following syndesmotic fixation: a comparison of screws retained in situ versus routine removal: is it really necessary?Injury. 2013; 44(12):1880–1884.
10.1016/j.injury.2013.08.011Crossref, Google Scholar
- 28.Cottom JM, Hyer CF, Philbin TM, Berlet GC. Treatment of syndesmotic disruptions with the Arthrex Tightrope: a report of 25 cases. Foot Ankle Int. 2008; 29(8):773–780.
10.3113/FAI.2008.0773Crossref, Google Scholar
- 29.Hoenig JM, Heisey DM. The abuse of power: the pervasive fallacy of power calculations for data analysis. Am Stat. 2001; 55(1);19–24.
10.1198/000313001300339897Crossref, Google Scholar
- 30.Gillett R. Post hoc power analysis. J Appl Psychol. 1994; 79(5):783–785.
10.1037/0021-9010.79.5.783Crossref, Google Scholar