Fixation of syndesmotic disruption using bioresorbable screws.

OBJECTIVE

Fixation of syndesmotic disruption using bioresorbable screws to avoid secondary surgery for removal of the positioning screw.

INDICATIONS: Syndesmotic ligament disruption, i.e., associated with ankle fractures (AO type B and C injuries).

CONTRAINDICATIONS: Allergies to bioresorbable materials such as sutures containing polylactic acids. Open fractures with severe comminution or bone loss. Successful conservative management in older patients. Nonambulatory patients.

SURGICAL TECHNIQUE: In case of a syndesmotic disruption, one or two cannulated bioresorbable positioning screws are placed bicortically under image intensifier control to allow healing of the distal ligamentous junction between the fibula and tibia. Screws must be placed proximal to the cartilaginous part of the tibiofibular joint to avoid uneventful cartilage damage and arthrosis.

POSTOPERATIVE MANAGEMENT: Postoperatively, most patients are treated with a non-weight-bearing cast for 6 weeks. Casts are changed after 1 and 2 weeks postoperatively. After 6 weeks, weight bearing is initiated. Return to physically demanding work and sports is allowed after 10-12 weeks.

RESULTS

Eight patients with a 6- to 12-month follow-up period showed good clinical and radiologic results.