Favored location of a stabilizing screw for syndesmotic diastasis: Recommendation based on clinical and theoretical considerations

Abstract BackgroundAnkle injuries are common; however, simultaneous malleolar fractures and syndesmotic diastasis (SD) are relatively fewer. There is no consensus about the optimal technique for syndesmotic stabilization. We hypothesized that the optimal location of stabilization should be at the syndesmosis based on theoretical consideration. The aim of this study was to compare the various locations of a stabilizing screw and determinate the preferable location from clinical and theoretical viewpoints. Patients and MethodsOver a 10-year period, we retrospectively studied 63 consecutive adult patients with combined injuries. The malleolar fractures were internally stabilized with screws and plates, and stress tests were performed to re-confirm syndesmotic instability. The diastatic syndesmosis was stabilized with cortical screws under image intensifier guidance. In the present study, we enrolled patients with only one syndesmotic screw (55 patients) and divided them into the trans-syndesmotic (TR) or the supra-syndesmotic (SU) group. Clinical and functional outcomes between the two groups were compared. The favored location was determined based on the data analysis.ResultsWe followed 48 patients for at least one year (average, 1.8 years; range, 1.0-7.0 years). The TR group included 31 patients and the SU group included 17 patients. None of the clinical and functional comparisons were statistically significant (p > 0.05).ConclusionAlthough statistical comparison showed no significant differences, TR screw insertion has biomechanical and biological merits. The study’s failure to show clear advantages of TR screw insertion for clinical and functional outcomes can be attributed to the small sample size and early screw removal. Clinically, TR insertion of a screw with late removal (> 3 months) might be a better choice.Level of evidence: Therapy/Prevention, III, retrospective cohort study.