Abstract

Introduction: Acute ankle sprains are common injuries that significantly impact both sports and daily life. Approximately 20% of ankle fractures involve a syndesmotic injury. The aim of this study was to evaluate negative prognostic factors influencing surgical outcomes in tibiofibular syndesmotic injuries associated with ankle fractures. Methods: Data from 246 patients were analyzed to examine the impact of initial ankle dislocation, fracture type, and fixation method on postoperative complications and reoperation rates. Ankle joint fractures were treated with open reduction and internal fixation using a dedicated metal plate. Four methods of syndesmosis fixation were recorded: 1 three-cortical screw, 1 four-cortical screw, 2 screws, or an endobutton. Data analysis was performed using statistical software. Results: Key findings reveal no significant association between initial dislocation and the necessity for reoperation. However, smoking combined with dislocation significantly increases reoperation rates. The fixation method impacts outcomes: single four-cortex screws result in pain without infectious complications, whereas single three-cortex screws are frequently associated with infections. Males experience higher rates of fixation destabilization and infections, while females predominantly face prolonged pain. Conclusions: The study underscores the importance of considering patient-specific factors such as smoking, gender, and fixation technique in managing syndesmotic injuries. These insights advocate for personalized treatment approaches to enhance recovery and minimize complications. Future research should aim to corroborate these findings in larger, multicentric cohorts to refine surgical strategies for syndesmotic injury management.

Keywords: Ankle fracture, Syndesmotic injury, Tibiofibular syndesmosis, Dislocation, Open reduction and Internal fixation

List of abbreviations

AITFL- Anterior Inferior Tibiofibular ligament; PITFL- Posterior Inferior Tibiofibular Ligament; ORIF- Open Reduction and Internal Fixation; CAM- Controlled Ankle Motion; CT- Computed Tomography; AUC- Area Under the Curve; SD- Standard Deviation; AOFAS- American Orthopaedic Foot & Ankle Society Scale; SMFA- Short Musculoskeletal Function Assessment; DM- Diabetes Mellitus; BMI- Body Mass Index; ASA- American Society of Anesthesiologists Physical Status Classification System; O&M: Olerud-Molander Score; VAS- Visual Analog Scale; MSIS- Musculoskeletal Infection Society; KOOS- Knee Injury and Osteoarthritis Outcome Score

Highlights

1. Primary ankle dislocation is not a negative prognostic factor for reoperation.
2. Smoking combined with dislocation significantly increases reoperation risk.
3. Fixation with a three-cortical screw is linked to higher infection rates.
4. Males are more prone to infections and destabilization post-surgery.
5. Females predominantly face prolonged pain after syndesmotic fixation.