Syndesmosis and Syndesmotic Equivalent Injuries in Tibial Plafond Fractures. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Haller, Justin M.; Githens, Michael; Rothberg, David; Higgins, Thomas; Barei, David; Nork, Sean
• Is Part Of: Journal of orthopaedic trauma. Volume 33:Issue 3(2019)
• Publication Date: 2019-03
• Subjects: pilon -- pilon fracture -- ankle fracture -- ankle osteoarthritis -- syndesmosis; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000001363
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: To identify the incidence and fracture characteristics associated with syndesmotic injury in tibial plafond fractures and report the incidence of posttraumatic osteoarthrosis (PTOA). Design: Retrospective comparative study. Setting: Two level-1 academic trauma centers. Patients/Participants: Of the 735 tibial plafond fractures (OTA/AO 43-B3 and 43-C) treated from January 2006 through December 2015, 108 patients (108/735, 15%) were identified with syndesmosis injury. Intervention: Either acute or missed syndesmotic injury. Main Outcome Measurement: PTOA. Results: Fourteen fractures (14/735, 2%) had missed syndesmotic injury. Volkmann fragment of ⩽10 mm ( P = 0.04) and fibular avulsion fracture ( P = 0.05) were significantly more common in missed syndesmosis. Ninety fractures (14/14 missed, 76/94 acute) had greater than 12-month follow-up (mean, 26 months; range, 12–102 months). Nearly all patients with missed syndesmosis injury developed arthrosis (13/14, 93%), and 45% (34/76 fractures) of plafond fractures with acute syndesmosis injury developed arthrosis ( P < 0.001). Although controlling for malreduction, patients with missed syndesmosis had significantly more PTOA development ( P = 0.018). Controlling for malreduction, patients with syndesmotic fixation and a ⩽10-mm Chaput or Volkmann fragment or fibular avulsion fracture (8/31, 26%) were less likely to develop PTOA than if they had a similar fracture pattern without syndesmotic fixation (9/10, 90%) ( P = 0.011). Conclusions: Fifteen percent of tibia plafond fractures have a syndesmosis or syndesmotic equivalent injury. Missed syndesmosis injury has a high rate of PTOA development. Patients with a ⩽10-mm Chaput or Volkmann fragment and/or fibular avulsion fracture benefit from syndesmotic fixation. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.