Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review

Houssemeddine Kouki; Aurélien Traverso; Thibaut Royon; Sami Abou-Khalil

doi:doi:10.11648/j.js.20210904.12

| Peer-Reviewed

Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review

Houssemeddine Kouki, Aurélien Traverso, Thibaut Royon, Sami Abou-Khalil

Published in Journal of Surgery (Volume 9, Issue 4)

Received: 10 May 2021 Accepted: 1 June 2021 Published: 15 June 2021

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Treatment of distal tibiofibular syndesmosis injuries requires an early and accurate reduction to prevent poor outcomes. Screw fixation technique remains the gold standard for syndesmosis injuries despite the increasing popularity of suture button fixation. We report the cases of three patients with acute distal tibiofibular syndesmosis injuries treated by open reduction and internal fixation using a plate and two screws. The objective of this study was to describe a different syndesmosis fixation technique with a two holes one-third tubular plate and two screws, relate the radiologic findings and analyze the functional outcomes. Clinical and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space at the final follow-up. Compared to preoperative values, postoperative values were improved with this method. Our findings suggest this new technique as a safe and reliable option to consider for the treatment of acute distal tibiofibular syndesmosis injuries. The main advantage is an optimal positioning of the screws on the lateral fibular cortex in the anteroposterior plan with an ideal space between them.

Published in	Journal of Surgery (Volume 9, Issue 4)
DOI	10.11648/j.js.20210904.12
Page(s)	153-158
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Ankle Injury, Syndesmosis Disruption, Open Reduction, Internal Fixation

References

[1]	Tyler J. Van Heest, Paul M. Lafferty. Injuries to the ankle syndesmosis. J Bone Joint Surg Am. 2014; 96: 603-13.
[2]	Malhotra K, Welck M, Cullen N, Singh D, Goldberg AJ. The effects of weight bearing on the distal tibiofibular syndesmosis: A study comparing weight bearing-CT with conventional CT. Foot Ankle Surg. 2019 Aug; 25 (4): 511-516.
[3]	Kim JH, Gwak HC, Lee CR, Choo HJ, Kim JG, Kim DY. A comparison of screw fixation and suture-button fixation in a syndesmosis injury in an ankle fracture. J Foot Ankle Surg. 2016 Sep-Oct; 55 (5): 985-90.
[4]	Olson KM, Dairyko GH Jr, Toolan BC. Salvage of chronic instability of the syndesmosis with distal tibiofibular arthrodesis: functional and radiographic results. J Bone Joint Surg Am 93: 66–72, 2011.
[5]	Bi O Jeong, Jong Hun Baek, Wook Jae Song. Ankle arthritis combined with chronic instability of the syndesmosis after ankle fracture with syndesmotic injury: a case report. The Journal of Foot & Ankle Surgery 57 (2018) 1000–1004.
[6]	Porter DA, Jaggers RR, Barnes AF, Rund AM. Optimal management of ankle syndesmosis injuries. Open Access J Sports Med. 2014; 5: 173–182.
[7]	Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int 1994; 15: 349-53.
[8]	Stiene A, Renner CE, Chen T, Liu J, Ebraheim NA. Distal tibiofibular syndesmosis dysfunction: a systematic literature review of dynamic versus static fixation over the last 10 years. J Foot Ankle Surg. 2019 Mar; 58 (2): 320-327.
[9]	Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke. Management of syndesmotic injuries: what is the evidence? World J Orthop. 2016 Nov 18; 7 (11): 718–725.
[10]	Schepers, T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. International Orthopaedics (SICOT) 36, 1199–1206 (2012).
[11]	Annie C. Weber, Michael G. Hull, Aaron J. Johnson, R. Frank Henn. Cost analysis of ankle syndesmosis internal fixation. Journal of Clinical Orthopaedics and Trauma 10 (2019) 173–177.
[12]	Qamar F, Kadakia A, Venkateswaran B. An anatomical way of treating ankle syndesmotic injuries. J Foot Ankle Surg. 2011; 50: 762–765.
[13]	Linzhen Xie, Huanguang Xie, Jinwu Wang, Chunhui Chen, Chuanxu Zhang, Hua Chen, Wenhao Zheng. Comparison of suture button fixation and syndesmotic screw fixation in the treatment of distal tibiofibular syndesmosis injury: A systematic review and meta-analysis. International Journal of Surgery 60 (2018) 120–131.
[14]	Pei Zhang, Yuan Liang, Jinshan He, Yongchao Fang, Pengtao Chen, Jingcheng Wang. A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury. BMC Musculoskeletal Disorders (2017) 18: 286.
[15]	Taylor DC, Tenuta JJ, Uhorchak JM, Arciero RA. Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med. 2007; 35: 1833–1838.
[16]	Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma. 2005 Feb; 19 (2): 102-8.
[17]	Klitzman R, Zhao H, Zhang LQ, Strohmeyer G, Vora A. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int. 2010 Jan; 31 (1): 69-75.
[18]	Mustafa. Seyhan, Ferdi Donmez, Mahir Mahirogullari, Selami Cakmak, Serhat Mutlu, Olcay Guler. Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures. Injury, Int. J. Care Injured 46S (2015) S19–S23.
[19]	Jung-Han Kim, Heui-Chul Gwak, Chang-Rack Lee, Hye-Jeung Choo, Jeon-Gyo Kim, Dae-Yoo Kim. A Comparison of Screw Fixation and Suture-Button Fixation in a Syndesmosis Injury in an Ankle Fracture. The Journal of Foot & Ankle Surgery 55 (2016) 985–990.
[20]	Brian Thornes, Fintan Shannon, Anne-Marie Guiney, Paul Hession, Eric Masterson. Suture-Button Syndesmosis Fixation Accelerated Rehabilitation and Improved Outcomes. Clinical Orthopaedics and Related Research Number 431, pp. 207–212.
[21]	Jun-Young Leea, Jae Hwan Limb, Gu-Hee Jung. Radiological indicator of reduction adequacy during ankle syndesmosis surgery: a computational cadaveric study. Injury, Int. J. Care Injured 49 (2018) 1491–1496.
[22]	Miller AN, Barei DP, Iaquinto JM, Ledoux WR, Beingessner DM. Iatrogenic syndesmosis malreduction via clamp and screw placement. J Orthop Trauma. 2013 Feb; 27 (2): 100-6.

Cite This Article

Plain Text BibTeX RIS

APA Style

Houssemeddine Kouki, Aurélien Traverso, Thibaut Royon, Sami Abou-Khalil. (2021). Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review. Journal of Surgery, 9(4), 153-158. https://doi.org/10.11648/j.js.20210904.12

Copy | Download

ACS Style

Houssemeddine Kouki; Aurélien Traverso; Thibaut Royon; Sami Abou-Khalil. Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review. J. Surg. 2021, 9(4), 153-158. doi: 10.11648/j.js.20210904.12

Copy | Download

AMA Style

Houssemeddine Kouki, Aurélien Traverso, Thibaut Royon, Sami Abou-Khalil. Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review. J Surg. 2021;9(4):153-158. doi: 10.11648/j.js.20210904.12

Copy | Download

@article{10.11648/j.js.20210904.12,
  author = {Houssemeddine Kouki and Aurélien Traverso and Thibaut Royon and Sami Abou-Khalil},
  title = {Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review},
  journal = {Journal of Surgery},
  volume = {9},
  number = {4},
  pages = {153-158},
  doi = {10.11648/j.js.20210904.12},
  url = {https://doi.org/10.11648/j.js.20210904.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.12},
  abstract = {Treatment of distal tibiofibular syndesmosis injuries requires an early and accurate reduction to prevent poor outcomes. Screw fixation technique remains the gold standard for syndesmosis injuries despite the increasing popularity of suture button fixation. We report the cases of three patients with acute distal tibiofibular syndesmosis injuries treated by open reduction and internal fixation using a plate and two screws. The objective of this study was to describe a different syndesmosis fixation technique with a two holes one-third tubular plate and two screws, relate the radiologic findings and analyze the functional outcomes. Clinical and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space at the final follow-up. Compared to preoperative values, postoperative values were improved with this method. Our findings suggest this new technique as a safe and reliable option to consider for the treatment of acute distal tibiofibular syndesmosis injuries. The main advantage is an optimal positioning of the screws on the lateral fibular cortex in the anteroposterior plan with an ideal space between them.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review
AU  - Houssemeddine Kouki
AU  - Aurélien Traverso
AU  - Thibaut Royon
AU  - Sami Abou-Khalil
Y1  - 2021/06/15
PY  - 2021
N1  - https://doi.org/10.11648/j.js.20210904.12
DO  - 10.11648/j.js.20210904.12
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 153
EP  - 158
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20210904.12
AB  - Treatment of distal tibiofibular syndesmosis injuries requires an early and accurate reduction to prevent poor outcomes. Screw fixation technique remains the gold standard for syndesmosis injuries despite the increasing popularity of suture button fixation. We report the cases of three patients with acute distal tibiofibular syndesmosis injuries treated by open reduction and internal fixation using a plate and two screws. The objective of this study was to describe a different syndesmosis fixation technique with a two holes one-third tubular plate and two screws, relate the radiologic findings and analyze the functional outcomes. Clinical and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space at the final follow-up. Compared to preoperative values, postoperative values were improved with this method. Our findings suggest this new technique as a safe and reliable option to consider for the treatment of acute distal tibiofibular syndesmosis injuries. The main advantage is an optimal positioning of the screws on the lateral fibular cortex in the anteroposterior plan with an ideal space between them.
VL  - 9
IS  - 4
ER  -

Copy | Download

Author Information

Houssemeddine Kouki

Clinic of Orthopaedic and Trauma Surgery, Fribourg District Hospital (HFR), Fribourg, Switzerland
Aurélien Traverso

Department of Orthopaedic and Trauma Surgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
Thibaut Royon

Department of Orthopaedic and Trauma Surgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
Sami Abou-Khalil

Department of Orthopaedic and Trauma Surgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Houssemeddine Kouki, Aurélien Traverso, Thibaut Royon, Sami Abou-Khalil. (2021). Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review. Journal of Surgery, 9(4), 153-158. https://doi.org/10.11648/j.js.20210904.12

Copy | Download

ACS Style

Houssemeddine Kouki; Aurélien Traverso; Thibaut Royon; Sami Abou-Khalil. Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review. J. Surg. 2021, 9(4), 153-158. doi: 10.11648/j.js.20210904.12

Copy | Download

AMA Style

Houssemeddine Kouki, Aurélien Traverso, Thibaut Royon, Sami Abou-Khalil. Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review. J Surg. 2021;9(4):153-158. doi: 10.11648/j.js.20210904.12

Copy | Download

@article{10.11648/j.js.20210904.12,
  author = {Houssemeddine Kouki and Aurélien Traverso and Thibaut Royon and Sami Abou-Khalil},
  title = {Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review},
  journal = {Journal of Surgery},
  volume = {9},
  number = {4},
  pages = {153-158},
  doi = {10.11648/j.js.20210904.12},
  url = {https://doi.org/10.11648/j.js.20210904.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.12},
  abstract = {Treatment of distal tibiofibular syndesmosis injuries requires an early and accurate reduction to prevent poor outcomes. Screw fixation technique remains the gold standard for syndesmosis injuries despite the increasing popularity of suture button fixation. We report the cases of three patients with acute distal tibiofibular syndesmosis injuries treated by open reduction and internal fixation using a plate and two screws. The objective of this study was to describe a different syndesmosis fixation technique with a two holes one-third tubular plate and two screws, relate the radiologic findings and analyze the functional outcomes. Clinical and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space at the final follow-up. Compared to preoperative values, postoperative values were improved with this method. Our findings suggest this new technique as a safe and reliable option to consider for the treatment of acute distal tibiofibular syndesmosis injuries. The main advantage is an optimal positioning of the screws on the lateral fibular cortex in the anteroposterior plan with an ideal space between them.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review
AU  - Houssemeddine Kouki
AU  - Aurélien Traverso
AU  - Thibaut Royon
AU  - Sami Abou-Khalil
Y1  - 2021/06/15
PY  - 2021
N1  - https://doi.org/10.11648/j.js.20210904.12
DO  - 10.11648/j.js.20210904.12
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 153
EP  - 158
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20210904.12
AB  - Treatment of distal tibiofibular syndesmosis injuries requires an early and accurate reduction to prevent poor outcomes. Screw fixation technique remains the gold standard for syndesmosis injuries despite the increasing popularity of suture button fixation. We report the cases of three patients with acute distal tibiofibular syndesmosis injuries treated by open reduction and internal fixation using a plate and two screws. The objective of this study was to describe a different syndesmosis fixation technique with a two holes one-third tubular plate and two screws, relate the radiologic findings and analyze the functional outcomes. Clinical and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space at the final follow-up. Compared to preoperative values, postoperative values were improved with this method. Our findings suggest this new technique as a safe and reliable option to consider for the treatment of acute distal tibiofibular syndesmosis injuries. The main advantage is an optimal positioning of the screws on the lateral fibular cortex in the anteroposterior plan with an ideal space between them.
VL  - 9
IS  - 4
ER  -

Copy | Download