Ankle syndesmotic injury: Tightrope vs screw fixation, A clinical academic survey

The goal of the study is to find out the treatment of choice for ankle fractures involving syndesmotic injury based on level of experience of orthopaedic surgeons.

A survey was undertaken to analyse the management used for ankle fractures with syndesmotic injuries AO 44c in a 35-year-old patient. Surgeons attending an orthopaedic course were invited to take part in a survey sorted into groups: junior surgeons middle grades, and experienced. Pictures of an x ray were shown to the participants and treatment options were asked.

100 surgeons from 20 nations took part in the event. Juniors made up 39%, registrars made up 38%, and experienced doctors were 29%. Screws, were reported by 93% for syndesmosis fixation. 66% of surgeons who used screws for syndesmosis fixation favoured a single screw over two screws.3-4 cortices were virtually evenly divided in choice, with 54% preferring three and 46% preferring four cortices. Only 22% of the time did they utilise a washer with their screws. With 52% of patients, the most typical time for permitting them to weight bear was 4-6 weeks after surgery. At 1-2 months postoperatively, 34% preferred to remove the screw, and at 2-3 months postoperatively, 29% preferred to remove the screw.

Data show that the majority of junior level doctors handle their patients according to AO principles. The majority prefer one 3.5 mm screw positioned between 2 and 4 cm above the ankle joint, with three cortices being somewhat preferred. Despite the lack of data to support one procedure, the majority of people remove their screws within 1-3 months.