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Type: Journal article
Title: Common pitfalls in syndesmotic rupture management: a clinical audit
Author: Symeonidis, P.
Iselin, L.
Chehade, M.
Stavrou, P.
Citation: Foot & Ankle International, 2013; 34(3):345-350
Publisher: Amer Orthopaedic Foot & Ankle Soc Inc
Issue Date: 2013
ISSN: 1071-1007
Statement of
Panagiotis D. Symeonidis, Lukas D. Iselin, Mellick Chehade, and Peter Stavrou
Abstract: Background: Syndesmotic injuries occur in up to 11% of all ankle injuries. Whereas the optimal fixation of syndesmotic injuries remains controversial, pitfalls in their management can lead to poor outcomes. Materials and Methods: This is a retrospective study of all ankle fractures operated on at a level 1 trauma center over a 7-year period. All cases with syndesmotic fixation were classified and patients’ notes and x-rays were reviewed. The timing of definitive syndesmotic fixation, the type of fixation (screw size and number, number of cortices), and the number of unplanned, syndesmotic-related reoperations were recorded. Seventy syndesmotic ruptures were operated on during the study period. Results: There were 19 unplanned reoperations. The 3 reasons for reoperation identified were failure to diagnose the syndesmotic injury 9/19 (47%), failure to achieve an anatomic reduction 6/19 (31%), and loss of reduction due to fixation failure 4/19 (21%). The type of fixation was not correlated with the failure rate, nor were the experience of the surgeon, the gender or the age of the patient. Conclusions: The reoperation rate for syndesmotic fixation may be higher than previously thought. In order to reduce the pitfalls in their treatment, we emphazise the importance of 3 critical points in the management of these injuries: suspect the injury, document the stability of the syndesmosis, and reduce the fibula anatomically. Level of Evidence: Level III, retrospective comparative series.
Keywords: syndesmotic injury; diastasis; failure; outcome
Rights: © The Author(s) 2013
RMID: 0020128004
DOI: 10.1177/1071100712470914
Appears in Collections:Orthopaedics and Trauma publications

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