Intramedullary osteosynthesis for ankle fractures and distal tibiofibular syndesmotic disruption

Introduction The optimal surgical approach for malleolar fractures and distal tibiofibular syndesmotic (DTFS) disruption remains controversial. There is no uniform treatment protocol for this type of injury.

The objective was to review modern surgical treatments of the pathology and determine the optimal option.

Material and methods Articles of French, English, Uzbek, Kazakh, German, Danish, Japanese and Chinese authors were retrospectively reviewed. An internet search of MedLine; PubMed; Scopus; Web of Science, CINAHL, the Cochrane Central Register of Controlled Trials databases was performed.

Results Comparative studies of dynamic fixation and static fixation of the DTFS showed advantages of the dynamic methods enabling precise, anatomical syndesmotic fixation and faster healing. Dynamic fixation methods would require no implant removal, while syndesmotic screw woul be taken off to reduce compression in the ankle joint and minimize a risk of malreduction facilitating mobility of the ankle joint. Dynamic methods are associated with greater stability and less complication rate. However, static methods have the advantages of being more accessible and less expensive, which can be an important factor choosing a treatment method. Static methods are a wide application and can be used in a wide range of clinical cases. Long-term results show no statistically significant differences between dynamic fixation and static fixation.

Discussion Literature review indicates the dynamic method with suture-button, a combined method and titanium cable isotonic annular fixation system as the preferred technique for surgical stabilization of distal syndesmosis associated with ankle fractures with a lower risk of postoperative complications and the possibility of short-term rehabilitation.

Conclusion The choice between dynamic and static methods of distal syndesmosis fixation depends on many factors, including the complexity of the injury, the availability and cost of implants and the experience of the surgeon.

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