Early weightbearing after dynamic stabilization of the ankle syndesmosis: A retrospective case series

Abstract

Ankle fractures with syndesmosis disruption present a challenge for foot and ankle surgeons. After open reduction internal fixation (ORIF), conventional postoperative treatment requires a period of immobilization and non-weightbearing, which if prolonged, can be detrimental to patients. The purpose of this case series is to present outcomes of early weightbearing after ankle fracture ORIF requiring syndesmosis stabilization using a dynamic fixation device. Thirty consecutive patients from August 2019 to July 2021 were included. Medical records and radiographs were reviewed to determine patient and surgical characteristics, postoperative complications, and reduction maintenance. Surgical treatment consisted of ORIF of malleolar fractures and stabilization of the syndesmosis with a Tightrope® XP (Arthrex Inc., Naples, FL). The mean age was 49 years. Mean BMI was 28.8. There were 24 supination-external rotation and 6 pronation-external rotation injuries. Twenty-six patients had syndesmosis fixation with a single implant, and 4 patients had syndesmosis fixation with two implants. The average time to weightbearing in a walking boot was 9.7 days. Average follow up was 13 months. One patient developed early postoperative saphenous neuritis, which resolved with conservative measures. There were no infections, malunions or nonunions, and all patients maintained fracture and syndesmosis reduction. In conclusion, the Tightrope® XP provides a safe and effective method for treatment of ankle fractures with syndesmosis disruption and supports early weightbearing after ORIF in an active healthy population. The results of this study are comparable to prior studies and show there is a low risk of complication and need for routine removal of implants.

Keywords

• Ankle fracture
• Dynamic fixation
• Flexible fixation
• Syndesmosis