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Indian Journal of Orthopaedics Surgery

Comparative Study of Tricortical versus Quadricortical Syndesmosis Fixation in Ankle Fractures

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Author Details: Sachin Jain, Dinesh Sonkar, Sunil Rajan

Volume : 1

Issue : 3

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 132

Article End Page : 137


Objective: To assess short-term functional results in 2 types of syndesmotic fixation, comparing the traditional rigid quadricortical syndesmotic screw fixation with a more dynamic tricortical screw fixation.

Method: PATIENTS: Thirty nine patients (Age group: 20 to 50 yr) with closed ankle fractures in which the syndesmosis was found to be unstable clinically, radiographic and confirmed intra operatively. INTERVENTION: The unstable syndesmoses were fixed with either one cortical screw through both tibial cortices (n = 18) QSF or two cortical screws engaging only 1 cortex of the tibia (n = 21) TSF. The quadricortical and the tricortical screws were removed only in the case of discomfort. However, all quadricortical screws were removed at 6 month follow up. Rehabilitation was the same in both groups. DESIGN: Prospective, randomized single blinded clinical study. SETTING: Department of orthopaedics and traumatology MGM Medical College & M Y Hospital Indore. And G.R. Medical College & Jayarogya Hospital, Gwalior.
Results: At the end of three months mean OM score was 65.35 (55 to75) For TSF group as compared to59.58 (55 to65) in QSF group. Mean values were similar between the two groups with respect to pain, swelling, support, running and jumping. The overall difference noted in two groups was due to difference in Mean value for functional parameter like stair climbing, Squatting and activities of daily living. At six months there was no significant difference in any parameter of OM score. Hence the overall scores were with non-significant difference {TSF76.42 (70 To 80) and QSF72.42 (65 to 80).
A three months DID was 12.07 (9to17) in TSF and 9.75 (6to13) in QSF with significant difference in two groups. At six months difference was non significant 4.75 for TSF and 4.42 for QSF Group. The one set of tricortical screws and two Quadricortical were removed in patients due to infection. Quadricortical group was re-operated in 3 (16.66 %) cases for screw removal in case of screw breakage before 6 month follow up. While one set of tricortical screws were removed due to loosening. All removal was done after 4 months as all fractures shown clinical and radiological union at 3 months.
Conclusions: In this study confirmed that Syndesmosis fixation with 2 tricortical screws is safe and improves early function. After 6 months, however, there were no significant differences between the 2 groups in functional score, pain, and dorsiflexion.

Keywords: DID: Difference in dorsiflexion, OM Score: Olerud Molender Score QSF quadricortical screw fixation TSF Tricortical screw fixation