Distal Tibiofibular Malreduction in Ankle Fractures Received Fibula Plate and Syndesmotic Screw Fixation

The aim of the study was to examine the effect of the position of the plate and syndesmotic screw on postoperative tibiofibular joint malreductions in cases where the syndesmotic screw is inserted through the hole of the anatomically locked lateral distal fibula plate.

Thirty patients (13 female and 17 male patients) with postoperative computed tomographic scans were examined retrospectively. Patient information (eg, tibiofibular congruence measured from postoperative computed tomographic scans, the anterior and posterior tibiofibular distance at axial sections, the presence and orientation of fibular rotation, the presence of tibiofibular intraarticular piece, the angle between the syndesmotic screw and incisural line, the placement of the plate, and the localization of the screw on the fibula in axial images) was recorded.

Those with fibular internal rotation had a lower syndesmotic screw-incisural line angle (SIA) (P = .001).There was a very strong negative significant correlation between the tibiofibular angle and SIA (rho, -0.780; P = .001). The median tibiofibular angle was found to be higher in cases with the fibula plate placed anteriorly (P = .009).The median SIA was found to be lower in cases with the fibula plate placed anteriorly (P = .004).The rate of placement of syndesmotic screw in the anterior third of the fibula was found to be high in cases with the fibula plate placed anteriorly (P = .049).

In ankle fractures treated with insertion of a syndesmotic screw through the plate, the orientation of the syndesmotic screw in the axial plane and the position of the plate may be associated with the incidence of postoperative syndesmosis malreduction.