Clinical Comparison Of Different Treatments For Distal Tibiofibular Syndesmosis Injury In Supination External Rotation- Type Ankle Fracture

1 ObjectiveTo study optimal surgical management in treatment of distal tibiofibular syndesmotic injury in supination external rotation ankle fractures via comparing clinical outcomes of conservative therapy and screw fixation and cortical bone anchor fixation.2 MethodsIt is a clinical retrospective study, 82 patients who met inclusion criteria had been picked out from patients suffered from supination external rotation ankle fractures accompanied by the distal-tibiofibular syndesmotic injury and been treated respectively with conservative therapy, screw fixation, cortical bone anchor fixation in orthopaedic and trauma department of He Fei NO.1 People,s hospital before December 2015. In the conservative therapy group,24 patients were treated with conservative management,while all 30 patients in screw fixation group were fixed by cortical bone screw, the anchor fixation group which include 28 patients who were healed with cortical bone anchor fixation. The evaluating index adopted in study include operation time, the time which were consumed to return to work, the data of distal tibiofibular syndesmotic reduction on anterior-posterior ankle joint X-rays, meanwhile, score functional outcomes of ankle according to the Baird-Jackson ankle joint scoring system. Finally, all relevant data were analysised statistically.3 ResultsThe mean operative time in conservative therapy group was(100.83±22.44) minutes, the average operative time of screw fixation group was(107.50 ±23.55) minutes, the mean operative time in bone anchor fixation group was(121.07±23.42) minutes, the operative time of bone anchor fixation group longer than conservative therapy group and screw fixation group evidently,statistical differences of operative time had been found between bone anchor fixation group with other groups. the average time that the patients consumed to return to work after surgery in conservative therapy group was(105.00±16.87)days, in screw fixation group was(101.67±16.36)days, in bone anchor fixation group was(91.25±16.38)days, the time that the patients consumed to return to work had been shortened in bone anchor fixation group when compared with conservative therapy group and screw fixation group,statistical differences of average time that the patients consumed to return to work had been found between bone anchor fixation group with other groups. Baird-Jackson scoring system was applied to evaluate functional outcome of ankle joint half a year after surgery, the excellent and good rate of conservative therapy group was 29.2% and the average score of ankle function was(86.79±5.63),the excellent and good rate of screw fixation group was 50% and the average score of ankle function was(90.23±5.30), the excellent and good rate of bone anchor fixation group was 78.6% and the average score of ankle function was(94.67±4.84),statistical differences had been found between bone anchor fixation group with other groups when comes to score of ankle function.4 ConclusionOperative intervention in treatment of the distal tibiofibular syndesmotic injury in supination external rotation-type ankle fracture can able to obtain preferable outcome than conservative therapy.Compared with treatment effect of cortical bone screw fixation, anchor fixation can able to shorten the time which the patient consumed to return to work, achieve favorable short-term function of ankle joint. Meantime, there is no routine need to remove cortical bone anchor postoperatively. It is feasible that the application of cortical bone anchor fixation in treatment of the distal tibiofibular syndesmotic injury in supination external rotation-type ankle fracture.