DYNAMIC FIXATION WITH FIBER TAPE INTERNAL BRACING FOR DISTAL TIBIOFIBULAR SYNDESMOTIC INJURIES - A PROSPECTIVE COHORT STUDY
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Keywords
syndesmotic injury, fibre tape internal brace, dynamic fixation, AOFAS ankle- hindfoot score
Abstract
BACKGROUND & OBJECTIVES: Distal Tibiofibular syndesmotic fixation is paramount important in ankle fracture fixation. Syndesmosis is crucial for integrity of ankle joint and thus for weight bearing. Traditionally, syndesmotic screws are used, but there are increasing reports of screw breakage, loosening, and stiffness due to prolonged immobilization required to protect the screws. Recently, dynamic fixation of syndesmosis using fibre tape internal bracing has gained popularity. The study was planned to evaluate functional outcome of fiber tape internal bracing in syndesmotic injury of ankle joint in a tertiary care center, Kerala. MATERIALS AND METHODS: A prospective cohort study was done for 34 patients with ankle syndesmotic injury for whom fiber tape internal bracing was done. Data was collected using a structured proforma one year after surgery . The evaluation of results is based on scoring system given by AOFAS ankle hindfoot score, one year after surgery. RESULTS: The mean age of patients was 39.06, with 61.8% in the age group 20-39 years. Males constituted 64.7% . Type-b Weber constituted 64.7%. Right ankle was more affected (58.8%). 38.2% had diabetes. 26.5% had pain at 1 year follow-up. 17.6% had post-op infection. Post-op AOFAS ankle hindfoot score at one year was good or above in 70.6% patients. 59.1% of type-B and 91.7% of type-C weber had good and above functional outcome (p-value= .204). Good and above functional outcomes were seen in 100% non-diabetic and 76.9% diabetic patients (p-value < .001). Good and above functional outcomes were seen in 82.1% patients with no post-op infection and 16.7% patients with post-op infection (p-value < .001). 100% of patients of age group 0-40 years, 77.8% of patients of the age group 40-60 years and 75% of patients above 60 years had good and above functional outcome (p value <0.001). The mean time taken for fracture healing was 14.18 ± 3 weeks. None of the patients required a second surgery for removal of implant during the study period.
CONCLUSION: Fiber tape internal bracing in ankle syndesmotic injury greatly improves the functional outcome and allows early rehabilitation. It offers standardized elastic fixation without the need for a secondary procedure for implant removal.
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Akshay M
Senior resident Orthopaedics, Government Medical College, Thiruvananthapuram
Shyam Roy A S
Associate Professor Orthopaedics, Government Medical College, Thiruvananthapuram
Jayachandran N
Associate Professor Orthopaedics, Government Medical College, Thiruvananthapuram
Shibu R
Associate Professor Orthopaedics, Government Medical College, Thiruvananthapuram
