Trends in Managing Ankle Fracture with Diastasis Radiological Assessment
Adnan A Faraj*; James Ricketts; Syed Bokhari
Introduction: The ankle diastasis fixation includes screw or tightrope fixation. The radiological improvement, the debates about the complication of either methods of fixation, continue. The current paper studies the trend followed in our area.
Material and methods: This is a retropsective study on fifty one patients who have had syndesmotic fixation for ankle fracture with diastasis treated in Scarborough-York Hospitals between 2011-2014. Radiological assessment of the ankle mortice before and after fixation, the clinical outcome following surgery are studied by going through the electronic medical notes and the picture archive and communicaton system (PACS) a mean follow-up period of 2.9 years.
Results: The mean number of tight ropes used were 2 (1-3), inserted 2 cm above tibial articular surface was used in 15 patients, persistent pain and swelling was encountered n 3 patients. In 36 cases, syndesmotic screw fixation was used for diastasis. Eight patients with high fibular fracture were treated solely with syndesmotic screw(s) without plate fixation of fibula, in the remaining cases the diastasis screw were inserted through fibular plate. In regards to the number of diastasis screws, one screw was used in all but seven patients. in three patients, the screw size was 4.5 and cortical; the remaining patients had 3.5 mm screws. The diastasis across was quadricortical in two patients only. Average distance of the diastasis screws from the tibial articular surface was 2.39 (1-5 ) cm. Seventeen diastasis screws were eventually removed, among which 14 screws were broken. There was minimal radiological deterioration of reduction following screw removal. The screws were removed at an average time of 31 weeks (6-133).
Conclusion: Both methods of diastasis fixation are popular, removal of screw and complications related to this remained to be a cause of concern, however, diastasis screw fixation remains to be a popular option to secure the syndesmosis after ankle injury. 47% of these cases, needed to have the screws removed. Localised swelling and pain was associated to tight ropes (20%). Cost implications and learning curve for using tightrope need to be taken in consideration.