Is Tricortical Screw Better than Quadricortical Screw in Syndesmotic Fixation of Ankle Fractures?
Mustafa Salah Hasan and Dhia Jafar Alsaadi and Falah Kadhim Hasan*
F.I.C.M.S Orthopaedic, Alkadhimain Medical City, Baghdad, Iraq
*Corresponding Author: Falah Kadhim Hasan, F.I.C.M.S Orthopaedic, Alkadhimain Medical City, Baghdad, Iraq.
April 14, 2021; Published: May 20, 2021
Background: Ankle fractures associated with syndesmotic injuries are increasing in number, need early detection and proper treatment. The distal tibiofibular articulation held by ligaments anteriorly and posteriorly in addition to the interosseous ligament, these ligaments resemble the syndesmosis. There are many methods for syndesmotic fixation includes screws or tight rope. Also there are much research about the number of screws and how many cortices should engage.
Objectives: To assess the early functional and radiological outcome in two types of syndesmotic fixation comparing the rigid quadricortical syndesmotic fixation with the more dynamic tricortical syndesmotic fixation.
Subjects and Methods: An analytic prospective comparative study was done in Al-Imamain Al-kadhimain medical city from Jun 2019 to October 2020, comparing the early functional and radiological outcomes of patients treated with tricortical versus quadricortical syndesmotic screw fixation in ankle fractures. The study conducted on 20 patients (13 males, 7 females) ranging in age between 19-56 years old, presented with clinical and radiological evidence of syndesmotic injury concomitant with ankle fracture either Weber B supination external rotation (SER) or Weber C pronation external rotation (PER) and pronation abduction (PA). The two different surgical approaches classified randomly every other case in to two groups, Group 1 (10 patients) treated by open XI reduction and internal fixation (ORIF) of ankle fracture with tricortical screw fixation for their syndesmotic injury, and Group 2 (10 patients) treated by open reduction and internal fixation (ORIF) of ankle fracture with quadricortical screw fixation for their syndesmotic injury. The patients were followed up for a period of 6 months.
Results: The AOFAS ankle hind-foot score was significantly higher for patients treated with tricortical syndesmotic screw (mean = 70.9 ± 5.4) than patients treated with quadricortical syndesmotic screw (mean = 62.6 ± 4.4) (p = 0.002) at 3 months. After 6 months the score was not significantly higher for tricortical group (mean = 84.1 ± 9.1) compared to quadricortical group (mean = 80.3 ± 5.9) (p = 0.286). There was significant difference for pain which is lower in tricortical group (mean = 31.0 ± 3.1) compared to quadricortical group (mean = 24.0 ± 5.1) (p = 0.002).after 6 months there was no significant difference Between the two groups (p = 0.355).
Conclusion: Fixation with either tricortical screw or quadricortical screw for syndesmotic injury improve function of the joint in ankle fractures with syndesmotic injuries. There was no significant differences in functional or radiological outcomes between the two groups after six months of treatment.
Keywords: Ankle Fractures; Syndesmosis; Syndesmotic Injuries; Syndesmotic Fixation
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