Favored location of a stabilizing screw for syndesmotic diastasis: Recommendation based on clinical and theoretical considerations

Abstract Background Although ankle injuries are common, combined malleolar fractures and syndesmotic diastasis (SD) are relatively fewer. The optimal technique for syndesmotic stabilization has yet achieved consensus. The favored location of a stabilizing screw for SD was investigated clinically and theoretically. Methods For the 10-year period, 63 consecutive adult patients with combined injuries were retrospectively studied. After malleolar fractures were internally stabilized with screws and plates, stress tests were performed to re-confirm syndesmotic instability. The diastatic syndesmosis was stabilized with cortical screws under image intensifier guidance. In the present study, only patients with one syndesmotic screw (55 patients) were enrolled and divided into the trans-syndesmotic (TR) or the supra-syndesmotic (SU) group. Clinical and functional outcomes between the two groups were compared. The favored location was speculated consequently.Results Forty-eight patients were followed for at least one year (average, 1.8 years; range, 1.0-7.0 years). The TR group included 31 patients and the SU group, 17 patients. All clinical and functional comparisons were not statistically significant (p > 0.05). Conclusions Although statistical comparison is insignificant, TR screw insertion possesses biomechanical and biological merits. Unable to reveal advantages of TR screw insertion in clinical and functional comparisons may be imputed to insufficient sample sizes and early screw removal. Practically, TR insertion of a screw with late removal (> 3 months) may be a better choice.