Discussion For Treatment Of SER/PER Ⅳ Combined With Separation Of Distal Tibiofibular Syndesmosis By Syndesmosis Screw

To evaluate the difference between using and not using syndesmotic screw to treat supination external rotation(SER)Ⅳ and pronation external rotation(PER)Ⅳ ankle fracture combined with seperation of distal tibiofibular syndesmosis.From March 1,2015 to January 30,2016,45 cases of ankle fracture combined with seperation of distal tibiofibular syndesmosis were treated,and syndesmotic screw was used in 22 cases(fixation group)and syndesmotic screw was not used in 23 cases(non-fixation group).There was no significant difference in gender,age,weight,cause of injury,side,injury to operation time,and fracture type between 2 group(P>0.05).The time for full weight-bearing,fracture healing time,and complications were recorded after operation.Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap(TBOL)and tibiofibular clear space(TBCS).Baird-Jackson score was used to evaluate functional recovery of the ankle.All incision healed by first intention without complications.The cases were followed up12-18 months(mean,14.8 months)in 2 groups.The time for full weightbearing was 10-12 weeks(median,11 weeks)in fixation group,which was significantly later than that in non-fixation group(6-10 weeks;median,8weeks)(Z= —5.552,P=0.000).X-ray examination showed reduction of separation of distal tibiofibular syndesmosis.All fractures healed.The fracture healing time was(14.50±1.22)weeks in fixation group,and was(14.66±1.15)weeks in non-fixation group,showing no significant difference(t= —0.429,P=0.670).No separation of distal tibiofibular syndesmosis,delayed union,nonunion,loosening,or breakage of fixation devices was observed in non-fixation group,but 1 case of breakage of syndesmosis screw was observed in fixation group.There was no significant difference in TBOL,TBCS,AOFAS score between 2 group(P>0.05).Considering the risk of fixation devices breakage,the full weight-bearing of non-fixation group were earlier than fixation group.No method could restore the stabilization as with physiology,so we could only find a balance point between insufficient stability and excessive stability.According to the study can say no significant influence on functional outcome of ankle or radiologic findings could bedetected whether syndesmotic fixation was given or not in treating supination external rotation(SER)Ⅳ and pronation external rotation(PER)Ⅳ ankle fracture(exclude Maisonneuve fracture)combined with seperation of distal tibiofibular syndesmosis,if the medial,lateral of the ankle could be effectively repaired and the posterior structures could be repaired according to the injury,.and non-fixation for syndesmotic was a better choice when full weightbearing was considered.