Evaluation of the syndesmotic screw in low Weber C ankle fractures

Objective: To determine the functional and radiographic outcome of low Webe r C ankle fractures and to evaluate the contribution of the syndesmotic scr ew in their outcome. Design: Prospective evaluation of a consecutive series. Setting: Level I trauma center. Patients: Forty-five patients divided into two groups matched for age, sex, and severity of injury. Twenty-six patients were treated with open reducti on, internal fixation, and a supplemental syndesmotic screw, and nineteen p atients were treated without a syndesmotic screw. Minimum time to follow-up was three years. Methods: A subjective, objective, and radiographic ankle scoring system was used. Logistical regression analysis was performed to determine whether th e presence or absence of a syndesmotic screw was a predictor of a poor outc ome. The likelihood ratio test was used to evaluate the significance of eac h variable in both univariate and multivariate analyses. Results: There was no statistically significant difference between either g roup, either using subjective outcome criteria (p = 0.86) or in ankle range of motion (p = 0.94). Logistical regression analysis indicated that fractu re dislocation could be used as a predictor of a poor outcome for either gr oup. Inadequate reduction and advancing age were also found to be significa nt predictors of a poorer outcome regardless of the use of a syndesmotic sc rew (p = 0.003, p = 0.004). Conclusions: Judicious fixation of Weber C type injuries within five centim eters of the ankle joint, with or without a syndesmotic screw, gives simila r results. Obligatory fixation of these fractures with syndesmotic screws a ppears to have no benefit and creates the need for an additional procedure.