Effects of three- or four-cortex syndesmotic fixation in ankle fractures

J Am Podiatr Med Assoc. Nov-Dec 2007;97(6):457-9. doi: 10.7547/0970457.


Background: There is no study comparing how Weber type C ankle fractures treated with either three- or four-cortex syndesmotic fixation affects the structure of the syndesmosis.

Methods: In a retrospective study, 46 patients were separated into two groups: 22 patients with three-cortex fixation and 24 patients with four-cortex fixation. All of the patients were evaluated clinically and radiographically at least 1 year after removal of the syndesmosis screws.

Results: There were three types of joint space obliteration: type 1, synostosis on plain radiographs; type 2, an incomplete bony bridge on magnetic resonance imaging with normal plain radiographs; and type 3, fibrous obliteration of the joint space. Although obliteration of the joint space was significant (P < .005) after four-cortex fixation, radiologic results did not affect the clinical outcome.

Conclusion: Four-cortex fixation for diastasis after an ankle fracture should not be a routine procedure. We advocate three-cortex fixation because the clinical results are no different and there is less syndesmotic space obliteration postoperatively.

MeSH terms

  • Adult
  • Aged
  • Ankle Injuries / surgery*
  • Bone Screws
  • Cohort Studies
  • Female
  • Fracture Fixation / methods*
  • Fractures, Bone / surgery*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome