Functional outcome by using American Orthopaedic Foot and Ankle Society: Ankle and hind foot scale scoring system of distal fibula fractures with syndesmotic injury managed by distal fibula anatomical locking compression plate and syndesmotic suture-button fixation
Authors: Juneja Johney , Gorakh Rahul , Garg Gaurav , Andrews Nitin , Mehra A K , Sen Ramesh 
Published: August 2023

Abstract

Background:
The study aimed to study the functional outcome by using American Orthopaedic Foot and Ankle Society (AOFAS)—ankle and hind foot scale scoring system of distal fibula fractures with syndesmotic injury managed by distal fibula anatomical locking compression plate and syndesmotic suture-button fixation.

Objective:
Solated fibula fractures are very common injuries. Diagnostic exams must rule out ankle instability. Surgical treatment must be considered in the case of associated ankle instability. Risk factors for wound related complications must be considered when choosing the surgical technique.

Materials and Methods:
The study was performed at the Ravindra Nath Tagore Medical College and Maharana Bhupal Government Hospital, Udaipur, in the Department of Orthopaedics and Traumatology. The type of the study is prospective. Inclusion criteria are as follows: Age above 18 years/skeletally matured; distal fibula fractures with Weber B and Weber C type of Danis–Weber classification; X-ray (stress view) suggestive of associated syndesmotic injury; and patients willing to give consent and willing for follow-up. Exclusion criteria are as follows: Weber A type fractures; distal fibula fracture without syndesmotic injury; pediatric and skeletally immature patients; compound injuries; and patients unfit for surgery. The sample size was 25.

Results:
Twenty-five cases were operated and followed up. A total of 22 cases (85%) had an excellent outcome, and three cases (15%) had a good outcome. The average AOFAS score is 92.84. All the patients at the end of 6 months were comfortable to do their day-to-day activities without any pains. No case required routine implant removal.

Conclusions:
Injuries to the syndesmosis are a diagnostic and therapeutic challenge to the orthopedic surgeon. The lack of clear radiographic parameters on which to make surgical decisions places greater importance on the physical examination and advanced imaging. Lack of injury to the deltoid ligament and posterior tibiofibular ligament based on magnetic resonance imaging is a reliable determinant to consider nonoperative treatment. Injury to the deltoid ligament or disruption of the relationship of the tibia and fibula typically is treated with surgical reduction and fixation. Use of the contralateral lower extremity is the most reliable in determining the normal relationship of the tibia and fibula for the patient both preoperatively and intraoperatively. Sagittal instability is more critical than coronal instability and must be taken into account when considering reduction of fixation of the syndesmosis. Further studies will determine the need for primary repair of the deltoid ligament and fixation of the posterior malleolus in the setting of ankle fracture and syndesmotic injuries. As the understanding of the longer term outcomes following injury to the syndesmosis advances, a logical algorithm to the treatment of these injuries should emerge.