The effect of headless double compression screw internal fixation on the rehabilitation process,fracture healing,and functional recovery of ankle fractures with associated lower tibiofibular syndesmosis ligament injury

SHEN Jian-wen; ZHENG Shaing-tuan

doi:10.3969/j.issn.2095-252X.2024.11.006

Abstract：Objective To investigate the application of headless double compression screw internal fixation in patients with ankle fractures accompanied by lower tibiofibular syndesmosis ligament injury.Methods A total of 104 patients with tibiofibular syndesmosis injury and ankle fracture in our Hospital from May 2021 to June 2022 were selected and divided into two groups with 52 cases in each group by random number table method.The control group received internal fixation with hollow screws and the observation group received internal fixation with headless double pressure screws.Surgical indexes,excellent and good ankle function rate,complications,ankle motion,inflammatory indexes[C-reactive protein(CRP),interleukin-6(IL-6),IL-8]and serum levels of hydrogen sulfide and irisin in the two groups were observed.Results The fracture healing time in the observation group was shorter than that in the control group,the differences were statistically significant(t=9.767,P=0.000).Three months after surgery,the excellent and good ankle function rate in the observation group(72.55％)was higher than that in the control group(52.00％),and the differences were statistically significant(x2=4.543,P=0.033).Six months after operation,the excellent and good ankle function rate of the observation group was 96.08％.Compared with 88.00％of the control group,no significant difference was observed(x2=2.259,P=0.133).At 3 and 6 months after surgery,the ankle dorsalis,plantar flexes,anterior rotation and posterior rotation angles in the observation group were higher than those in the control group,and the differences were statistically significant(t at 3 months after surgery was 8.242,13.871,17.865,11.241,and t at 6 months after surgery was 7.126,8.840,5.935,9.414,all P=0.000);at 1 week,1 month and 3 months after surgery,the levels of serum IL-6,CRP and IL-8 in the observation group were lower than those in the control group,and the differences were statistically significant(t at 1 week after surgery was 5.772,9.640,8.877;t at 1 month after surgery was 9.169,18.714,16.305;t at three months after surgery was 8.059,16.775,14.960;all P=0.000).At 1 and 3 months after surgery,the serum levels of hydrogen sulfide and irisin in the observation group were higher than those in the control group,and the differences were statistically significant(t 1 month after surgery was 4.028,5.348,all P=0.000;t3 months after surgery was 2.951,3.256,P was 0.004,0.002).The incidence of delayed healing in the observation group was 1.96％,which was lower than 18.00％in the control group,and the differences were statistically significant(x2=7.081,P=0.008).Conclusions Without making an ankle incision,the internal fixation of headless double compression screws can achieve anatomical reduction of ankle fractures,which can reduce the stimulation of soft tissue and blood circulation around the fracture,accelerate fracture healing,and promote early rehabilitation of ankle joint function compared to hollow screw fixation.