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Gomaa AR, Mason L. Chronic syndesmotic instability - Current evidence on management. J Clin Orthop Trauma 2024; 50:102382. [PMID: 38435397 PMCID: PMC10904910 DOI: 10.1016/j.jcot.2024.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
This review article discusses the current evidence on the management of chronic syndesmotic instability. Conservative treatment has a limited role, and surgical intervention is most commonly reported as the mainstay of treatment, however the literature consists of small case series and descriptions of operative techniques, and thus the evidence base for any treatment is weak. Surgical options include arthroscopic debridement alone, static fixation with cortical screws, dynamic fixation with suture-button devices, and ligamentous repair or augmentation.
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Affiliation(s)
- Abdul-Rahman Gomaa
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Lyndon Mason
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Sanda II, Hosin S, Vermesan D, Deleanu B, Pop D, Crisan D, Al-Qatawneh M, Mioc M, Prejbeanu R, Rosca O. Impact of Syndesmotic Screw Removal on Quality of Life, Mobility, and Daily Living Activities in Patients Post Distal Tibiofibular Diastasis Repair. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2048. [PMID: 38138151 PMCID: PMC10744725 DOI: 10.3390/medicina59122048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: While numerous studies have been conducted on syndesmotic screw management following distal tibiofibular diastasis repair, a clear consensus remains unclear. This research aims to evaluate whether the postoperative removal of syndesmotic screws leads to improved patient outcomes, specifically in quality of life, mobility, and daily living activities, and whether it offers a cost-effective solution. Materials and Methods: Patients with a history of unimalleolar or bimalleolar ankle fractures, classified according to the Danis-Weber and Lauge-Hansen systems, were included. Comprehensive evaluations were made via standardized questionnaires like the SF-36 Health Survey, HADS, and WHOQOL-BREF, distributed approximately 2 months post surgery. A total of 93 patients underwent syndesmotic screw removal while 51 retained the screws (conservative approach). Results: Patients who underwent screw removal reported superior satisfaction in mobility, with a score of 7.8, compared to 6.7 in the conservative approach (p = 0.018). Similarly, their ability to perform daily activities scored 8.1, higher than the 6.5 from the conservative cohort (p < 0.001). Pain levels were also more favorable in the screw removal group, with a score of 5.3 against 6.8 in the conservative group (p = 0.003). On the SF-36 physical domain, the screw removal group achieved a mean score of 55.9 versus 53.3 for the conservative group (p = 0.027). Notably, the HADS anxiety subscale highlighted reduced anxiety levels in the screw removal cohort with a mean score of 5.8 against 7.3 in the conservative group (p = 0.006). However, overall quality of life and recommendations to others showed no significant difference between the groups. Conclusions: Syndesmotic screw removal postoperatively leads to marked improvements in patients' mobility, daily activity abilities, and reduced postoperative pain and anxiety levels. However, overall quality of life was similar between the two approaches. The findings offer valuable insights for orthopedic decision making and patient-centered care concerning the management of syndesmotic screws after distal tibiofibular diastasis repair.
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Affiliation(s)
- Isabella-Ionela Sanda
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department of Laboratory Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Samer Hosin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.V.); (B.D.); (D.P.); (D.C.); (M.A.-Q.); (M.M.); (R.P.)
| | - Dinu Vermesan
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.V.); (B.D.); (D.P.); (D.C.); (M.A.-Q.); (M.M.); (R.P.)
| | - Bogdan Deleanu
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.V.); (B.D.); (D.P.); (D.C.); (M.A.-Q.); (M.M.); (R.P.)
| | - Daniel Pop
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.V.); (B.D.); (D.P.); (D.C.); (M.A.-Q.); (M.M.); (R.P.)
| | - Dan Crisan
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.V.); (B.D.); (D.P.); (D.C.); (M.A.-Q.); (M.M.); (R.P.)
| | - Musab Al-Qatawneh
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.V.); (B.D.); (D.P.); (D.C.); (M.A.-Q.); (M.M.); (R.P.)
| | - Mihai Mioc
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.V.); (B.D.); (D.P.); (D.C.); (M.A.-Q.); (M.M.); (R.P.)
| | - Radu Prejbeanu
- Department of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.V.); (B.D.); (D.P.); (D.C.); (M.A.-Q.); (M.M.); (R.P.)
| | - Ovidiu Rosca
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
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