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|Title:||Common pitfalls in syndesmotic rupture management: a clinical audit|
|Citation:||Foot & Ankle International, 2013; 34(3):345-350|
|Publisher:||Amer Orthopaedic Foot & Ankle Soc Inc|
|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|
|Appears in Collections:||Orthopaedics and Trauma publications|
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