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LETTER TO EDITOR  
Year : 2012  |  Volume : 46  |  Issue : 2  |  Page : 253
Evaluation of the syndesmotic-only fixation for Weber - C ankle fractures with syndesmotic injury: A comment


Department of Orthopedic Surgery, JPN Apex Trauma Centre, All India Institute of Medical sciences (AIIMS), Ansari Nagar, New Delhi, India

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Date of Web Publication10-Mar-2012
 

How to cite this article:
Meena S. Evaluation of the syndesmotic-only fixation for Weber - C ankle fractures with syndesmotic injury: A comment. Indian J Orthop 2012;46:253

How to cite this URL:
Meena S. Evaluation of the syndesmotic-only fixation for Weber - C ankle fractures with syndesmotic injury: A comment. Indian J Orthop [serial online] 2012 [cited 2020 Jan 26];46:253. Available from: http://www.ijoonline.com/text.asp?2012/46/2/253/93695
Sir,

We read with great interest the manuscript by Muhammed et al. [1] entitled "Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury". I must congratulate the authors for this study. However, I would like to draw attention of authors and readers to the following:

  1. The authors confirmed syndesmotic disruption with Cotton hook test. Rather than pulling the fibula laterally, stressing the fibula anteriorly and posteriorly in the sagittal plane is more reliable. Disruption of the syndesmosis will produce significant instability of the fibula that may be best appreciated in the sagittal plane. The improved sensitivity of this testing method was described in a cadaveric study. [2]
  2. The need for syndesmotic internal fixation is closely tied to the integrity of the medial malleolar osteoligamentous complex (MMOLC). Biomechanical studies have shown that when the MMOLC is intact, disruption of the syndesmosis does not lead to widening of the mortise. [3],[4] This implies that in cases when the medial malleolus is fixed, syndesmotic fixation is not indicated.
  3. Authors removed syndesmotic screw at an average of eight weeks. Removing the screw too early may allow recurrent diastasis of the syndesmosis, as evident in one case of the author's series. Late diastasis of the syndesmosis creates a much more difficult clinical problem than broken screws; it is advisable to leave the screw in place for at least 12 weeks. [5]


 
   References Top

1.Mohammed R, Syed S, Metikala S, Ali SA. Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury. Indian J Orthop 2011;45:454-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Candal-Couto JJ, Burrow D, Bromage S, Briggs PJ. Instability of the tibio-fibular syndesmosis: Have we been pulling in the wrong direction? Injury 2004;35:814-8.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Boden SD, Labropoulos PA, McCowin P, Lestini WF, Hurwitz SR. Mechanical considerations for the syndesmosis screw: A cadaver study. J Bone Joint Surg Am 1989;71:1548-55.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Burns WC 2 nd , Prakash K, Adelaar R, Beaudoin A, Krause W. Tibiotalar joint dynamics: Indications for the syndesmotic screw: A cadaver study. Foot Ankle 1993;14:153-8.  Back to cited text no. 4
    
5.Canale ST. Campbell's Operative Orthopaedics. 11th ed, Vol. 3, Chapter 51. Pennsylvania: Mosby Elsevier; 2009. p. 3090.  Back to cited text no. 5
    

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Correspondence Address:
Sanjay Meena
JPN Apex Trauma Centre, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.93695

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1 Authoręs reply
Mohammed, R. and Syed, S. and Metikala, S. and Ali, S.A.
Indian Journal of Orthopaedics. 2012; 46(2): 253-254
[Pubmed]



 

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