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Effects of Three- or Four-Cortex Syndesmotic Fixation in Ankle Fractures

Hasan Karapinar, MD ^*, Onder Kalenderer , Levent Karapinar, MD , Taskin Altay, MD , Metin Manisali, MD  and Izge Gunal, MD 

^* Orthopedics, State Hospital, Yesilyurt, Izmir, Turkey.
Orthopedics, Tepecik Hospital, and Department of Orthopedics, Social Security Hospital, Yenisehir, Izmir, Turkey.
Radiology, Dokuz Eylul University, and Department of Radiology, Dokuz Eylul University Hospital, Balcova, Izmir, Turkey.
Orthopedics, Dokuz Eylul University Hospital, Balcova, Izmir, Turkey.

Corresponding author: Izge Gunal, MD, Orthopedics, Dokuz Eylul University Hospital, Balcova, Izmir, 35340 Turkey.

Abstract

Background: There is no study comparing how Weber type C ankle fractures treated with either three- or four-cortex syndesmotic fixation affects the structure of the syndesmosis.

Methods: In a retrospective study, 46 patients were separated into two groups: 22 patients with three-cortex fixation and 24 patients with four-cortex fixation. All of the patients were evaluated clinically and radiographically at least 1 year after removal of the syndesmosis screws.

Results: There were three types of joint space obliteration: type 1, synostosis on plain radiographs; type 2, an incomplete bony bridge on magnetic resonance imaging with normal plain radiographs; and type 3, fibrous obliteration of the joint space. Although obliteration of the joint space was significant (P < .005) after four-cortex fixation, radiologic results did not affect the clinical outcome.

Conclusion: Four-cortex fixation for diastasis after an ankle fracture should not be a routine procedure. We advocate three-cortex fixation because the clinical results are no different and there is less syndesmotic space obliteration postoperatively. (J Am Podiatr Med Assoc 97(6): 457–459, 2007)