SYNDESMOTIC SCREW IN NEUTRAL POSITION IN ANKLE FRACTURE: A PROSPECTIVE OBSERVATIONAL STUDY

Document Type : Original articles: include clinical trials, interventional research, Basic researches and clinically relevant laboratory investigations

Authors

Orthopedic dept., Sohag Faculty of Medicine, Sohag, Egypt

Abstract

Background: Syndesmotic injuries are commonly associated with ankle fractures, particularly Danis-Weber type B and C fractures. The ideal ankle position during syndesmotic screw fixation remains debated. This study aimed to evaluate the clinical and radiological outcomes of syndesmotic screw fixation performed with the ankle in a neutral position. Methods: This prospective observational study included 20 adult patients with closed type B and C ankle fractures accompanied by syndesmotic injury, treated at Sohag University Hospitals. All patients underwent open reduction and internal fixation with intraoperative confirmation of syndesmotic instability via the Cotton test. Results: The mean age of patients was 37.5 ± 15.68 years, with males comprising 55% of the cohort. Motor car accidents were the predominant mechanism of injury (80%). No major complications were recorded; 55% of patients had an uneventful postoperative course. Partial weight-bearing began at a mean of 1.57 weeks, and all patients achieved full weight-bearing by 6 weeks. Radiographic union was observed at a mean of 6.2 weeks. VAS scores declined significantly from 7.00 at 2 weeks to 0.65 at 1 year (p < 0.0001), while AOFAS scores improved from 48.45 to 89.75 over the same period. ROM in both dorsiflexion and plantarflexion increased significantly at each follow-up (p < 0.0001). Conclusions: Fixation of syndesmotic injuries with the ankle held in a neutral position is a safe and effective technique. It facilitates early mobilization, results in timely fracture union, significantly reduces pain, and supports favorable functional recovery and joint mobility. These findings support the viability of neutral-position screw fixation as a standard approach in the management of syndesmotic ankle injuries.

Keywords

Egyptian Journal of Orthopedic Research
Volume 5, Issue 2
September 2025
Pages 101-109

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