The Effect for Syndesmotic Stability When Fixation of the Posterior Malleolar Fracture

Ye Xuenian; Zhu Wenxiong; Jiang Ming

Abstract：Objective To explore the effect of the posterior malleolar fixation on syndesmotic stability. Methods From March 2009 to April 2014,28 patients with posterior malleolar fractures and syndesmotic injuries underwent open reduction and internal fixation via the posterolateral approach. After posterior malleolar fixation,Hook-text was done to check the syndesmosis stability in order to decide whether dyndesmotic screws should be used. According to the Lauge-Hansen classification system, the cases include:3 of them were stage Ⅲ supination-external rotation(SER). 20 of them were stage IV supination-external ro-tation(SER),the other 5 of them were stage IV pronation-external rotation(PER). All patients had distal fibula and posterior malleolar fractures,and among them 25 had medial malleolar fractures and 5 had fracture dislacation of ankle joints. Results After fixation of the posterior malleolar fractures,27 patients got syndesmotic stability obtained,so no syndesmotic screw were needed. 1 patient still needed syndesmotic screws because of syndesmotic unstability. The average duration of the follow-up was 16. 3 months(7 ~ 26 monthes). The average time of bone union was 6. 5 monthes. The results were graded according to the score system of Olerud and Molander,23 cases were rated excellent(90 ~ 100),3 good(80 ~ 89),2 fair( < 80),the average point was 93. The rate of excellent and good was 92. 9% . Conclusion Fixation of the posterior malleolar enhance the syndes-motic stability and reduce the usage of a syndesmotic screw. More attention should be paid on dealing with posterior malleolar.