RESUMEN
Background Ankle syndesmotic injuries represent complex orthopaedic injuries, commonly requiring open reduction and fixation. Several techniques have been described for fixation, with syndesmotic screw fixation being traditionally considered as the 'gold standard'. Among the relatively new techniques developed, the TightRope system stabilisation provides 'dynamic' stabilisation with promising results. We aimed to evaluate the radiographic performance of these two different surgical techniques in the management of ankle fractures with an underlying syndesmotic injury. Methods A total of 85 cases were included in the study and were divided into two groups: syndesmotic screw fixation (48 cases) and TightRope system (37 cases). Patient demographics, type of ankle fracture and type of implant used were recorded for all the cases, and evaluation of the postoperative radiographs was performed for all. For all patients, the radiographic parameters assessed included the medial clear joint space (MCS), tibiofibular overlap (TFO), and anterior and posterior tibiofibular interval in order to calculate the anterior tibiofibular ratio (ATFR). Results Statistical analysis revealed no statistically significant differences in the radiographic parameters of the postoperative radiographs between the two groups. However, in the syndesmotic screw group, a higher incidence of radiographic malreduction was seen, as indicated by the MCS and ATFR parameters, in comparison to the TightRope fixation group. An equal distribution of radiographic abnormal parameters was noted among the different types of ankle fractures included in the study (trimalleolar, bimalleolar and isolated fibula fractures with syndesmotic injury) with no obvious positive correlation noted (Pearson correlation test). Conclusion Both surgical techniques seem to provide adequate reduction of the syndesmosis, with no statistical significant differences detected from the radiographic evaluation of both groups. In our study though, the syndesmotic screw group was associated with a higher incidence of radiographic malreduction as indicated by the MCS and ATFR parameters. The TightRope system seems to have a lower rate of radiographic malreduction and provides an equally effective way of syndesmosis fixation based on a dynamic mode of stabilisation.
RESUMEN
INTRODUCTION: Surgical treatment is usually recommended for the acute unstable acromioclavicular joint (ACJ) dislocations. Among the wide variety of different surgical techniques, the Double Endobutton and the Nottingham Surgilig technique are two of the most widely acceptable and well described techniques. The aim of this study was to offer a direct comparison of the above techniques in question, analysing the patients outcomes and assessing the risk of early loss of radiographic reduction. MATERIALS AND METHODS: A total of 48 patients who met the inclusion criteria were included in the study. Patients were categorised in two groups (Endobutton and Nottingham Surgilig group) and post operative assessment of the patients was performed using the Oxford Shoulder (OSS) and Constant Murley (CMS) scores. Patient demographics, hand dominance, ACJ classification and co-morbidities were included in the analysis and radiographic evaluation was conducted for both groups. RESULTS: Both techniques provide a good outcome in the management of unstable ACJ dislocations but the risk of early radiographic failure remains higher in the double Endobutton technique (26% vs. 17.39% for the Nottingham Surgilig group). Factors such as patients' demographics, hand dominance, co-morbidities and grade of ACJ separation do not seem to contribute to radiographic loss of reduction, whereas the incorrect positioning of the coracoid endobutton is a significant factor predisposing to early radiographic failure, P < 0.001. DISCUSSION: The incidence of early loss of radiographic reduction still remains high in both groups. In order to reduce this common complication, accurate placement of the coracoid endobutton under fluoroscopic intra-operative control is strongly recommended.