The Journal of Bone and Joint Surgery (American) 84:26-31 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Treatment of Syndesmotic Disruptions of the Ankle with Bioabsorbable Screw Fixation
W. David Hovis, MD,
Bryan W. Kaiser, MD,
Jeffry T. Watson, MD and
Robert W. Bucholz, MD
Investigation performed at the Department of Orthopaedic Surgery,
University of Texas Southwestern Medical Center at Dallas, and Parkland
Memorial Hospital, Dallas, Texas
W. David Hovis, MD
Hovis Orthopaedic Clinic, 501 19th Street, Suite 702, Knoxville,
TN 37916
Bryan W. Kaiser, MD
Robert W. Bucholz, MD
Department of Orthopaedic Surgery, University of Texas Southwestern
Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75235-8883
Jeffry T. Watson, MD
Anderson Orthopaedic Clinic, 2000 East Greeneville, Suite 3700,
Anderson, SC 29621
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. They did not
receive payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other
charitable or nonprofit organization with which the authors are
affiliated or associated.
A video supplement to this article is available from the Video
Journal of Orthopaedics. A video clip is available at the
JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can
be contacted at (805) 962-3410, web site: www.vjortho.com.
Background: Bioabsorbable implants have restricted
indications because of their unique biochemical properties and their
inferior biomechanical properties compared with those of conventional metallic
implants. The purpose of this prospective study was to assess the
efficacy of screws made of polylevolactic acid (PLLA) in the treatment
of syndesmotic disruptions associated with ankle fractures and fracture-dislocations.
Methods: Thirty-three consecutive patients with
a syndesmotic disruption were managed with standard metallic plate-and-screw fixation
of the malleolar fracture and with 4.5-mm polylevolactic acid screws,
with purchase in four cortices, for fixation of the syndesmosis.
Intraoperative radiographs confirmed reduction of the syndesmosis,
and all of the patients were managed with a non-weight-bearing plaster
splint or brace for six weeks. Clinical and radiographic assessment
and functional evaluation with use of the Olerud-Molander scoring system
were performed at the time of follow-up.
Results: Ten patients were lost to follow-up prior
to the twenty-four-month evaluation, leaving twenty-three patients
with an average duration of follow-up of thirty-four months (range, twenty-four
to forty-three months). All of the malleolar fractures healed in
an anatomical position at an average of three months, and no postoperative
displacement of the syndesmosis or widening of the medial clear
space was detectable on radiographs. No episodes of osteolysis or
late inflammation secondary to the hydrolyzed polylactide occurred.
Nineteen patients (83%) had an excellent result, and four
patients (17%) had a good result. All twenty-three patients
returned to their preinjury level of work and activities of daily
living. No patient had malunion, nonunion, loss of reduction, or
complications attributable to the biomechanical or biochemical properties
of the implants.
Conclusions: Polylevolactic acid screws are effective
in stabilizing disruption of the syndesmosis during healing of unstable
ankle fractures. In this small series, the bioabsorbable screw was
well tolerated, and there was no need for a second operation to remove
it.
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