OPERATIVE TREATMENT OF SYNDESMOTIC DISRUPTIONS WITHOUT USE OF A SYNDESMOTIC SCREW - A PROSPECTIVE CLINICAL-STUDY

A new protocol for the selected omission of transsyndesmotic fixation in Weber class C ankle fractures was prospectively evaluated in 21 con secutive patients. As proposed in a previous cadaveric study (J. Bone Joint Surg., 71A:1548-1555, 1989), the protocol suggested that transsy ndesmotic fixation was not required if (1) rigid bimalleolar fracture fixation was achieved or (2) lateral without medial fixation was obtai ned (i.e., with accompanying deltoid tears) if the fibular fracture wa s within 4.5 cm of the joint According to this protocol, only 3 of 21 patients ( 14%) required transsyndesmotic fixation. Ten of the patient s who did not receive transsyndesmotic fixation underwent pronation-ex ternal rotation stress radiographs in a fashion analogous to the previ ous cadaveric study. At 1- to 3-year follow-up, no stress (N = 10) or static view (N = 18) widening of the mortise or syndesmosis was seen i n any patient, which supports (with the above guidelines) a limited, r ather than routine, use of supplemental transsyndesmotic fixation. Cli nical results from this prospective study seem to substantiate previou sly proposed biomechanical guidelines for the selected omission of tra nssyndesmotic fixation Given these guidelines, transsyndesmotic fixati on was unnecessary in many cases and the need can be determined before surgery by assessing the integrity of the deltoid ligament and level of the fibular fracture.