The Medial Collateral Ligaments Repair Versus Syndesmotic Fixation In Supination External Rotation-4 Ankle Fractures

Objective: Ankle fracture is one of the most common lower limb fractures,accounting for about 9% of all fractures in the whole body.SER IV° ankle fracture is one of the most common types of ankle fracture in clinic,also known as Weber B ankle fracture,accounting for about 80% of all ankle fractures.The injuries of SER-4 ankle fracture are mainly divided into four parts: lateral malleolus,medial malleolus / medial collateral ligament(or deltoid ligament),posterior malleolus,lower tibiofibular ligament.And in the choice of treatment,depending on the stability of the ankle after treatment.Several scholars have shown that it have a negative impact on the prognosis of patients if treated conservatively.Therefore,patients with SER-4 ankle fracture often need surgery to restore ankle stability.At present,the main treatment scheme for SER-4 fracture is surgical treatment,but there is no uniform standard for specific internal fixation.From August 2016 to September 2017,open reduction and internal fixation of medial triangular ligament and syndesmotic screw fixation were performed in the third affiliated Hospital of Anhui Medical University.Clinical data of patients with SER-4 fracture,the operative time,intraoperative blood loss,fracture healing time,AOFAS score and excellent rate in one year after operation,the incidence of complications in the complete course of disease,and the ankle movement were studied in the two groups.In order to study the clinical significance of these two methods in ankle fracture.At the same time,a large number of anatomical and imaging data were consulted,and the biomechanical mechanism of ankle joint activity and SER-4 ankle fracture was studied,with a view to starting from these aspects.It provides a theoretical basis for the treatment of SER-4 ankle fracture and the causes of postoperative complications,and provides the direction for further study.Methods: Sixty-nine patients with SER-4 ankle fracture in Third Affiliated Hospital of Anhui Medical University from Aug 2016 to Sep 2017 were selected and categorized into two groups: 38 patients deltoid ligament repair are group A,and other 31 patients with syndesmotic fixation are group B.Internal fixation operation time,fracture healing time,AOFAS Ankle Hind-foot Scale,blood loss,range of motion of ankle joint were retrospectively analyzed.Results: There were no significant differences between the two groups in blood loss,the operation time and fracture healing time(P>0.05).Range of motion after operation and AOFAS Ankle Hind-foot Scale in group A is better than group B(P<0.05).All patients in the syndesmotic fixation group underwent a subsequent procedure for removal of the syndesmotic implant.There was significant difference between two group in the frequency of complications(P<0.05).Conclusion: ORIF+repairing the deltoid ligament can firmly restore ankle stability in SER-4 ankle fracture,and is superior to syndesmotic fixation in functional recovery,and can avoid inherits surgical risks that occur during a subsequent operation for removal of the syndesmotic implant.It is especially suitable for patients with high functional requirements of ankle joint.