One year of ankle fractures on the Wirral: how was the syndesmosis managed?

M.J. Grant, D.M. Machin, H. Carden, N.P. Unnikrishnan, S.R. Platt, M.S. Hennessy

Introduction: Ankle fractures are operated on by most trauma surgeons regardless of sub specialty. The subtlety of the Syndesmosis injury is very important and must not be missed.

Methods: We analysed 124 consecutive operated ankle fractures over 12 months in our institution. Data was collected on all patients who underwent surgery for ankle fractures from initial management to discharge. Radiographs, intra-operative data and clinical notes were reviewed by a single foot and ankle surgeon (DM). Exclusion criteria were; patients who had a manipulation only, skeletally immature patients, and non-ankle fractures. All should have had an intraoperative, radiographically documented syndesmosis test and, if unstable, fixation.

Results: Female:Male 77:47, mean age 49.0, range 14-97. The primary surgeon: senior registrar 46.8%, foot and ankle fellow or consultant 33.9%. Weber classification was A = 1.6%, B = 62.9%, C = 31.5%, isolated medial malleolar fractures = 4.0%. A documented intraoperative syndesmosis test was performed in 29.8% (hook = 37.9%, rotation = 56.8%, tap test = 5.4%) and of these 7 went on to have a syndesmosis fixation. Of the patients who did not have a documented intraoperative syndesmosis test, 2 patients progressed to revision surgery to fix the syndesmosis. The syndesmosis fixation used was (1 screw = 59.5%, 2 screws = 35.7%, 1 tightrope = 2.4%, 2 tightropes = 2.4%). A total of 5 patients (4.0%) who were operated on at the trust, went on to require revision surgery; 2 of these for an unstable syndesmosis post primary operation. Neither had a documented intraoperative Syndesmosis test. There was 1 patient who had their primary fixation elsewhere that required revision surgery at our trust for syndesmotic stabilisation.

Conclusion: We have demonstrated the importance of routinely testing and documenting the stability of the syndesmosis intraoperatively in all cases. This will help to decrease revision surgery.