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Immediate weightbearing
0%
13/2738
Subchondral debridement of any osteochondral defect
5%
147/2738
Repair of medial ligamentous structures
1%
29/2738
Casting or splinting in a neutral position postoperatively
3%
91/2738
Anatomic reduction of the syndesmosis
89%
2433/2738
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Long-term outcomes after an ankle syndesmotic injury are most correlated with an anatomic reduction of the ankle syndesmosis. Formal open reduction of the syndesmosis has been shown to improve outcomes by improving the reduction quality. While the importance of anatomic reduction of a syndesmotic injury is clear, controversy exists regarding the ideal method of fixation. No significant differences are reproducibly reported in regards to number of syndesmotic screws, size, or number of cortices. There is emerging data supporting the use of suture button fixation. Wikeroy et al. reviewed 48 patients at a mean of 8.4 years, and they found that patients with a difference in the syndesmotic width between the operated and the nonoperated ankle of 1.5 mm or more showed inferior results. Posterior malleolar fragments and obese patients also had worse outcomes. Schepers et al. published a review on the suture button device comparisons to traditional screw fixation, reviewing 6 biomechanical studies and 34 clinical studies. They found that the suture button systems have similar outcomes to screw fixation, but insufficient long-term and high-quality evidence prevented a strong conclusion. Implant removal in the suture button groups averaged 10%, while screw removal averaged 52%. Sagi et al. reviewed 107 patients with ankle fractures and associated syndesmotic injuries requiring surgery. They found that 39% were malreduced, but open reduction of the syndesmotic injury cut the malreduction rate by 2/3. They also reported that at a minimum of 2 years follow-up, patients with malreduced syndesmotic injuries demonstrated worse functional outcome scores. Figure A shows an ankle fracture with obvious syndesmotic injury/widening. Incorrect answers: 1-4: These choices are not correlated with excellent outcomes with treatment of a syndesmotic injury.
2.7
(16)
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