Abstract
Introduction
Ankle fractures are one of the most frequently encountered musculoskeletal injuries,
and 10% of patients have a concomitant distal tibiofibular syndesmotic disruption
necessitating surgical repair. A national survey was conducted to gain more insight
into the current approaches in the management of syndesmotic injuries in the Netherlands.
Materials and methods
A postal survey was sent to one or two staff members of the trauma and orthopaedic
surgery departments in each of the 86 hospitals in the Netherlands. Questions concerned
the pre-, per- and postoperative strategies and the different ideas on the type, number
and placement of the syndesmotic screw.
Results
A total of 85.2% of the trauma surgeons and 61.9% of the orthopaedic surgeons responded
(representing 87% of all hospitals). Syndesmotic injury was judged mainly using the
‘Hook test’. Syndesmotic injuries in a Weber-B ankle fracture were treated with one
screw in 81.2% of cases and in Maisonneuve injuries mainly with two screws. The 3.5-mm
screw was used most frequently over three cortices at 2.1–4.0 cm above the tibial plafond. Removal of the syndesmotic screw was routinely done by
87.0% of surgeons, mostly between 6 and 8 weeks. Of all respondents, 62.3% showed
interest in participating in a randomised controlled trial comparing standard removal
with removal on indication.
Conclusion
Compared with previous surveys our survey is more complete, has the highest response
rate and has almost national coverage. Most individual items reviewed compare well
with current literature, except for the routine removal of the syndesmotic screw,
which might not be encouraged from a literature point of view. For this reason, the
results of the current survey will be used in the development of a multicentre randomised
controlled trial comparing the functional outcome in routine removal of the syndesmotic
screw compared with removal on indication.
Keywords
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Article info
Publication history
Accepted:
June 17,
2012
Identification
Copyright
© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
