Overview
Injuries to the distal tibiofibular syndesmosis are common and occur in an estimated 25% of all rotational ankle fractures. Anatomic reduction of the syndesmosis has been associated with improved functional outcome as well as decreased rates of posttraumatic arthritis. Both screw fixation and suture fixation have become accepted standards of care for treatment of syndesmotic injuries. Recent literature would suggest trends favoring suture fixation over screw fixation with improved quality of syndesmotic reduction, postoperative range of motion, and improved maintenance of syndesmotic reduction. However, the evidence remains heterogeneous, and patient reported outcomes have failed to show a superiority of one method over the other. Additionally, there have been no studies that demonstrate objective gait outcomes comparing screw versus suture fixation for syndesmotic injuries.
Description
This will be a prospective randomized study. Patients with isolated rotational ankle injuries with syndesmotic instability will be randomized to either screw fixation or suture fixation for treatment of their syndesmotic injury. Patients will be followed postoperatively for one year following surgery with documentation of both clinical outcomes and subjective patient reported outcomes. Additionally, postoperative gait patterns will be measured and compared between patients who had syndesmotic injuries treated with screw fixation versus suture fixation
Eligibility
Inclusion Criteria:
- Adults 19 years of age and older.
- Isolated rotational ankle injury
- Syndesmotic instability (determined either pre- or intra-operatively)
- Length-stable fibula fracture pattern
Exclusion Criteria:
- Open fracture
- Length-unstable fracture pattern (including Maisonneuve fracture pattern)
- Syndesmotic stability (determined either pre- or intra-operatively)
- Lower extremity neuropathy
- History of prior trauma or surgery to injured ankle
- Non-ambulatory patient
- Baseline use of ambulatory assistive device prior to injury