Highlights
- •Early full weight bearing post-syndesmotic fixation was not associated with early radiographic diastasis at 6 weeks.
- •Early full weight bearing post-syndesmotic fixation was not associated with late radiographic diastasis at 12 weeks.
- •There was no association between immobilization in boot or cast and post-operative diastasis.
- •There is no association with weight bearing status and negative secondary post-operative outcomes.
Abstract
Objective
To analyse whether early post-operative full weight bearing following syndesmotic
ankle fixation affected radiographic outcomes suggestive of diastasis.
Design
Retrospective comparative cohort study over a two year period.
Setting
Level 1 trauma centre
Patients/Participants
152 consecutive patients sustaining an unstable ankle fracture requiring syndesmotic
stabilisation were included. Exclusions were 49 patients who had trimalleolar fixation
without syndesmosis screws, one patient who had concomitant ankle and talar fracture.
Five patients were lost to follow up and eleven patients were followed up in other
centres. A total of 86 patients were analysed
Intervention
Protected or full weight bearing.
Main Outcome Measurement
The primary outcome measure was early diastasis. The secondary outcomes were late
diastasis, wound complications and re-operation. Analysis of variance was used for
the predictor variable of weight bearing status. We assumed a priori that p values of less than 0.05 were significant.
Results
Median age was 36 (IQR 30), with 54 males and 32 females. Median follow up was 12
weeks (IQR 6). There was no significant difference when comparing weight bearing status
and change in radiographic measurements intra-operatively compared to 6 and 12 week
follow up radiographs (tibiofibular clear space p = 0.799, tibiofibular overlap p = 0.733
and medial clear space p = 0.261).
Conclusion
After surgical stabilization of an unstable syndesmotic injury, full weight bearing
did not lead to syndesmotic diastasis in the early post-operative period. Full weight
bearing is recommended following ankle fixation which includes syndesmotic fixation.
Keywords
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Article info
Publication history
Published online: February 20, 2019
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