Early Weight Bearing on a Fixed Syndesmosis. Does it Matter?

Abstract

Category: Trauma Introduction/Purpose: Introduction: There is no consensus about when to allow weight bearing in ankle fractures in which a screw was used to maintain reduction of the syndesmosis. There has been no evaluation, of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged. The aim of this study was to evaluate the radiographic parameters of the syndesmosis over time in patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Methods: We analyzed 42 patients with ankle fractures treated in our institution, with at least one syndesmotic screw in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). We measure medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS) and talar shift (TS). Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Also no difference was found in measurements within patients with intact versus broken screws (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable consequences on plain X rays regarding ankle joint parameters. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We believe aggressive functional rehabilitation after ankle fractures including early weight bearing is beneficial for our patients and may lead to improved functional results.