Postoperative Retrospective Study Of The Abruption Of Distal Tibiofibular Syndesmotic Combined With Ankle Fracture

Objective:To analyze the signs of syndesmosis separation from preoperative andpostoperative X-ray examination taken by Weber B and Weber C ankle fractures causedby ankle-sprain.To weight on the diagnostic value of X-ray examination for injury ofdistal tibiofibular syndesmosis in different types of ankle fractures,and look into thefeatures of X-ray examinations of the ankle after the bone structure were restored in theoperation.To provide reference for the diagnosis and treatment in the abruption of distaltibiofibular syndesmotic combined with ankle fracture.Methods:This study selected170cases of surgical Weber B and Weber C anklefracture patients from October2008to May2014in the Second Affiliated Hospital ofDalian Medical University,and did the retrospective analysis. All patients were dividedinto group Weber B ankle fracture and group Weber C ankle fracture.129examples ingroup Weber B fractures,52male,77female, aged from18to65years old, mean42.9years old;41examples in group Weber C fractures,27male,14female, aged from13to59years old, mean41.9years old. The type of ankle fractures were determined by thesigns of postoperative radiograph. The features of the X-ray examinations of the anklewere observed after the bone structure were restored in the operation. The tibial medial malleolus clearance and tibiofibula overlap width were measured by ZLPACS Viewersoftware. The effects of Gender and age were statistically analyzed in X-rayexamination’s result before and after the surgery.To identify the effects of gender，ageon the diagnostic value of radiographic measurements for injury to the distal tibiofibularsyndesmosis of different types of ankle fractures.Results:There are129examples in group Weber B fractures,52male,77female,age from18to65years old, mean53.6years old;41examples in group Weber Cfractures,27male,14female, age from13to59years old, mean49.9years old. Thestatistical analysis shows that the difference is statistical significant (P <0.05) whendifferent genders are divided into group Weber B and group Weber C in X2test.The age factor in different groups is not statistically significance (P>0.05); Thereare10patients underwent fixations for a syndesmotic injury in group Weber B,119patients had not been fixed, of which33postoperative X-ray plain film show the signsof tibiofibular separation,89no signs of separation.statistical analysis show that Kappa=0.288, P <0.05. in diagnosis of preoperative and postoperative X-ray examinations ofinferior tibiofibular separation;There are19patients underwent fixations for asyndesmotic injury in group Weber C,22patients had not been fixed, of which11postoperative radiographs show the signs of tibiofibular separation,11no signs ofseparation.statistical analysis show that Kappa=0.481, P <0.05in diagnosis ofpreoperative and postoperative X-ray examinations of inferior tibiofibular separation.X2test results between the groups of the changes in signs of preoperative andpostoperative X-ray examination statistically significant: X2=4.289, P <0.05.Conclusion: The sensitivity of X-ray examination is not good enough at diagnosisof syndesmosis separation combined with Ankle fractures that caused by twist. thereare significant differences of signs in X-ray examination, and the agreement is at lowlevel.The level of agreement in group Weber B is worse than group Weber C, whichmay be due to the fracture location in syndesmosis levels can interfere the measurementon the X-ray film by Doctors. The same as the preoperative diagnosis of patients withnegative tibiofibular separation, In group Weber C, The postoperative X-ray results of patients without fixed syndesmosis the positive possibilities is greater than group WeberB. Although many distal tibiofibular syndesmosis injury associated in ankle fracturesdon’t have indications widely accepted for surgical fixation, but the ankle joint spacestill are still abnormal even if the bony structure is rigid fixed.There must be hazard inthe long run.Therefore, preoperative history-taking and the damage process and thepreoperative diagnosis with the Lauge-Hansen classification combined with X-ray filmare very important, but the decision of fixing the syndesmosis needs to rely on theexamination in the operation.