An Update on Management of Syndesmosis Injury: A National US Database Study

We conducted a study to determine the incidence of syndesmotic injury and stabilization within various ankle fracture patterns along with the rate of syndesmotic implant removal. All data were obtained from a publicly available for-fee healthcare database, the PearlDiver Patient Records Database. Current Procedural Terminology (CPT) codes were used to search the database for cases of fixation of lateral malleolus, bimalleolar, and trimalleolar fractures in addition to syndesmotic fixation and implant removal. Open reduction and internal fixation (ORIF) was performed for an ankle injury in 54,767 patients during 2007 to 2011. Total number of ORIF procedures was higher with each decade of life: 3206 cases in patients younger than 20 years, and 10,609 cases in patients 70 to 79 years old. Frequency of syndesmotic fixation increased significantly with ORIF of all ankle fractures (P < .0001). Hardware removal decreased throughout the study period. Incidence of syndesmotic injuries and rate of operative management trended upward over the study period, and rate of hardware removal decreased.