Syndesmotic diastasis and it’s relation to the functional outcome in ankle fractures

Author(s): Dr. Ramu AC, Dr. Y Nishanth Shetty, Dr. Afroz Ahmed M, Dr. Bharath Krishnamurthy and Dr. Nishaanth R

Abstract: Ankle fractures are among the most common injury treated by orthopaedic surgeons. Syndesmotic injuries represent the severity of the ankle injuries. However, they are difficult to evaluate, have a lengthy recovery period, and may disrupt normal joint functioning if not appropriately treated. These ankle injuries are disastrous if not appropriately treated specially to athletes and those engaged in heavy work on irregular surfaces. Hence treating these ankle injuries are of utmost importance. The aim of this study was to assess the functional outcome in ankle fractures with syndesmotic diastasis and without syndesmotic diastasis. To provide guidelines for intra-operative assessment of syndesmotic stability. To find out the complications occurring in each group. This was a prospective observational study conducted in yenepoya medical college hospital from October 2017 to October 2020. In this study 42 patients were treated and each equally were divided into two groups with syndesmotic injury and without syndesmotic injury. Open reduction and internal fixation with locking / one third tubular plate with 3.5 system for lateral malleolus and 4 mm CC screws for medial malleolus for fractures without syndesmotic injury and fracture with syndesmotic injury additional 4mm screw was put, which was evaluated. Diagnosing the syndesmotic instability preoperatively wasn’t adequate. However when combined with intraoperative assessment by checking for translational movements and cottons test; it was found to be more reliable. Open reduction and anatomical fixation is required to obtain good results. A simple syndesmotic screw will suffice the job and the screw needs to be removed before weight-bearing in order to avoid screw breakage. To conclude, the functional outcome scores were lower in syndesmotic group. However, we need to assess the functional outcomes in a longer time frame to see if any statistically significant difference actually exists or not.

DOI: https://doi.org/10.22271/ortho.2021.v7.i3j.2817