The Efficacy Comparison Of Two Fixed Ways In Treating The Ankle Fracture Of Supination External Rotation Ⅳ° With Tibiofibular Syndesmosis Separation

Objective : To compare the clinical efficacy of two fixation of the supination external rotation Ⅳ degree ankle fracture with tibiofibular syndesmosis separation with simple repair the anterior,posterior tibiofibular ligament,and tuberosity,screw fixation.Methods:37 patients were divided into two groups according to different methods of fracture fixation.17 patients were only to fix the tibiofibular anterior and posterior tuberosity and repair the anterior and posterior ligament,inferior tibiofibular syndesmosis without screw fixation(non-fixed group).This group including 14 males and 3 females,the number of left was 6 versus and the number of right was 11.The mean age of the patients was 39.6 ± 12.3 years;20 patients were fixed with inferior tibiofibular syndesmosis screw(fixed group).This group consisted of 12 males and 8 females,the number of left was 10 versus and the number of right was 10.The average age was 36.5 ± 9.8 years old.They were followed up by a period ranging from 12 months to 18 months(average16.6 months).We evaluated the ankle by the tibiofibular clear space(TBCS)and inferior tibiofibular overlap distance(TBOL)at 3 days and at the last follow-up X-ray examination and AOFAS ankle scores at the last follow-up.Results: All patients were followed up,the incision was healed,fracture healing time is 10 to 20 weeks,an average of 16 weeks.The two groups were not significantly different in TBCS and TBOL at the 3 days after operation and the last follow-up(P > 0.05).The AOFAS Ankle-Hindfoot Scale score was 94.29 ± 4.79 in the non-fixed group and 92.86 ± 6.73 in the fixed group.In the non-fixed group,10 cases were excellent,5 cases were good,2 cases were normal and 0 cases were bad,The fine rate was 88%.In the fixed group,13 cases were excellent,5 cases were good,2 cases were normal and 0 cases were bad,And the fine rate was 90%.The AOFAS Ankle-Hindfoot Scale score(P> 0.05)and the excellence rate(P> 0.05)of the two groups were no significant difference.In the fixed group,one patient had an ankle pain at 2 weeks postoperatively,and remained no improvement until the pain was removed at 12 weeks after surgery.There was no complication in the non-fixed group.Conclusions : Simple fixation of anterior and posterior tibiofibular ligament and tuberosity may achieve the effect of syndesmosis screws to repair inferior tibiofibular syndesmosis for the patient of supination external rotation Ⅳ degree ankle fracture with syndesmosis separation.While the former need not to remove screw secondary and can reduce the risk of malreduction,tibiofibular screw broken or loosening.