[Fixation of syndesmotic disruption using bioresorbable screws]. van der Elst Maarten,Coster Erwin,Dekker Maarten Operative Orthopadie und Traumatologie OBJECTIVE:Fixation of syndesmotic disruption using bioresorbable screws to avoid secondary surgery for removal of the positioning screw. INDICATIONS:Syndesmotic ligament disruption, i.e., associated with ankle fractures (AO type B and C injuries). CONTRAINDICATIONS:Allergies to bioresorbable materials such as sutures containing polylactic acids. Open fractures with severe comminution or bone loss. Successful conservative management in older patients. Nonambulatory patients. SURGICAL TECHNIQUE:In case of a syndesmotic disruption, one or two cannulated bioresorbable positioning screws are placed bicortically under image intensifier control to allow healing of the distal ligamentous junction between the fibula and tibia. Screws must be placed proximal to the cartilaginous part of the tibiofibular joint to avoid uneventful cartilage damage and arthrosis. POSTOPERATIVE MANAGEMENT:Postoperatively, most patients are treated with a non-weight-bearing cast for 6 weeks. Casts are changed after 1 and 2 weeks postoperatively. After 6 weeks, weight bearing is initiated. Return to physically demanding work and sports is allowed after 10-12 weeks. RESULTS:Eight patients with a 6- to 12-month follow-up period showed good clinical and radiologic results. 10.1007/s00064-007-1207-5

[Comparison of short-term effectiveness of metal screws and absorbable screws in repair of distal tibiofibular syndesmosis]. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery Objective:To compare the short-term effectiveness of repairing distal tibiofibular syndesmosis with metal screws and absorbable screws. Methods:A retrospective analysis was performed on the clinical data of 63 patients with ankle fracture combined with injury of the distal tibiofibular syndesmosis admitted between January 2017 and January 2020. Among them, 31 patients were treated with absorbable screw fixation of the distal tibiofibular syndesmosis (research group) and 32 patients were treated with metal screw fixation of the distal tibiofibular syndesmosis (control group). There was no significant difference in gender, age, cause of injury, surgical side, time from injury to operation, fracture type, preoperative visual analogue scale (VAS) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score between the two groups ( >0.05). The operation time and fracture healing time were recorded and compared between the two groups. X-ray film was taken to evaluate the effect of ankle joint reduction and fixation. Olerud-Molander ankle fracture efficacy score (short for OM score), AOFAS score, and VAS score were used to evaluate the effectiveness. Results:There was no significant difference in operation time between the two groups ( =-0.683, =0.497). In the control group, 1 case of delayed healing and 1 case of poor healing occurred in the lateral incision after operation, which healed after dressing change; the rest of the patients had primary healing of the incision. Patients in both groups were followed up 12-24 months, with an average of 13.8 months. In the control group, 1 patient with fracture of pronation and external rotation walked with full weight bearing after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks after operation, the anatomical plate of the lateral malleolus was broken, and the lateral malleolus was fixed again and recovered after 5 months; 1 patient had mild ankle pain after operation, and the pain disappeared after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks. No complication such as nerve and blood vessel injury occurred in all patients. There was no significant difference in fracture healing time between the two groups ( =-1.128, 0.264). The AOFAS and VAS scores significantly improved in both groups at 12 months after operation ( <0.05). There was no significant difference between the two groups in the OM scores, and the difference of AOFAS and VAS scores between before and after operation ( >0.05). Conclusion:Using absorbable screws to repair the distal tibiofibular syndesmosis can effectively restore the ankle acupoint structure, prevent ankle instability, and restore good ankle function. There is no significant difference in effectiveness between absorbable screws and metal screws, and there is no need for secondary operation to remove screws. 10.7507/1002-1892.202201101