Clinical Study On The Treatment Of Inferior Tibiofibular Joint Injury By Homemade Steel Wire Strapping Fixation

Objective: To compare the clinical effects of homemade wire strapping fixation with cortical screw fixation in the treatment of inferior tibiofibular joint injuries.Methods: The clinical data of patients with ankle fracture combined with distal tibiofibular syndesmosis separation who were treated in our hospital from January 2019 to January 2022 were collected.After screening according to the inclusion and exclusion criteria,a total of 25 adult patients’ information was collected.Hook test and C-arm fluoroscopy were used to evaluate the stability of distal tibiofibular syndesmosis.According to the surgical methods for the treatment of distal tibiofibular syndesmosis separation,the patients were divided into self-made steel wire fixation group and cortical screw fixation group.The general data of the included patients were as follows: there were 4 male patients and 7 female patients in the self-made wire strapping fixation group,with a total of 11 patients.In the cortical screw fixation group,there were 6 male patients and 8 female patients,with a total of 14 patients.All patients were between 20 and 70 years old.The injury types of the patients were self-sprain,traffic accident,and falling from height.According to the Lauge-Hansen classification,there were 8 cases of supination-external rotation type,13 cases of pronation-external rotation type,and 4 cases of pronation-abduction type.The operation time,intraoperative blood loss,postoperative VAS score,postoperative incision infection and internal fixation fracture were compared between the two groups.The reduction of distal tibiofibular syndesmosis was evaluated according to the X-ray images of the ankle joint at 2 weeks after operation and 15 months after operation..The ankle function of patients was followed up at 4 months,6 months and 12 months after operation,and the ankle joint rating scale(AOFAS)was used to score.All data were statistically analyzed and compared to comprehensively evaluate the clinical effect of the two surgical methods in the treatment of distal tibiofibular syndesmosis injury.Results: All the 25 patients were followed up for 15 months.No postoperative incision infection occurred,and only 1 case of screw fracture occurred in the cortical screw group.Self-made steel wire binding group: intraoperative blood loss(20.36±3.30)ml;The postoperative VAS score was 7(6,8).The tibiofibular syndesmosis space was(3.05±0.19)mm at 2 weeks after operation.(3.57±0.62)mm after complete removal of internal fixator;The AOFAS scores at 6 and 12 months after operation were 83.27±0.83 and 96.18±0.55,respectively.Cortical screw fixation group: intraoperative blood loss(21.79±3.85)ml;The postoperative VAS score was 6(6,7).The tibiofibular syndesmosis space was(3.49±0.20)mm at 2 weeks after operation.(3.93±0.73)mm after complete removal of internal fixator;The AOFAS scores at 6 and 12 months after operation were(83.79±0.54)and(94.29±0.85),respectively,and there was no significant difference between the above two groups(P>0.05).The operation time of the self-made steel wire fixation group was 17(16,19)min,which was longer than that of the cortical screw fixation group 9(7.75,10.25)min,and the difference was statistically significant(P<0.05).The AOFAS score of the self-made steel wire fixation group(67.18±0.62)was higher than that of the cortical screw fixation group(56.43±0.91)at 4 months after operation,and the difference was statistically significant(P<0.05).Conclusions: 1.Both self-made steel wire strapping and cortical screw fixation can reliably treat distal tibiofibular syndesmosis injury,and the short-term clinical effect of self-made steel wire strapping fixation is better than that of cortical screw fixation.2.As a new surgical method,self-made steel wire strapping can avoid an additional operation to remove the internal fixation device of distal tibiofibular syndesmosis.3.Compared with other elastic fixation devices,self-made steel wire binding is easier to remove the internal fixator,and the price is low,which significantly reduces the economic burden of patients.