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Effects of Three- or Four-Cortex Syndesmotic Fixation in Ankle Fractures

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  • 1 Orthopedics, State Hospital, Yesilyurt, Izmir, Turkey.
  • | 2 Orthopedics, Tepecik Hospital, and Department of Orthopedics, Social Security Hospital, Yenisehir, Izmir, Turkey.
  • | 3 Radiology, Dokuz Eylul University, and Department of Radiology, Dokuz Eylul University Hospital, Balcova, Izmir, Turkey.
  • | 4 Orthopedics, Dokuz Eylul University Hospital, Balcova, Izmir, Turkey.
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Background: There is no study comparing how Weber type C ankle fractures treated with either three- or four-cortex syndesmotic fixation affects the structure of the syndesmosis.

Methods: In a retrospective study, 46 patients were separated into two groups: 22 patients with three-cortex fixation and 24 patients with four-cortex fixation. All of the patients were evaluated clinically and radiographically at least 1 year after removal of the syndesmosis screws.

Results: There were three types of joint space obliteration: type 1, synostosis on plain radiographs; type 2, an incomplete bony bridge on magnetic resonance imaging with normal plain radiographs; and type 3, fibrous obliteration of the joint space. Although obliteration of the joint space was significant (P < .005) after four-cortex fixation, radiologic results did not affect the clinical outcome.

Conclusion: Four-cortex fixation for diastasis after an ankle fracture should not be a routine procedure. We advocate three-cortex fixation because the clinical results are no different and there is less syndesmotic space obliteration postoperatively. (J Am Podiatr Med Assoc 97(6): 457–459, 2007)

Corresponding author: Izge Gunal, MD, Orthopedics, Dokuz Eylul University Hospital, Balcova, Izmir, 35340 Turkey.