Journal of Musculoskeletal Trauma

Treatement of Diastasis of the Distal Tibiofibular Syndesmosis: Woo Chun Lee, Han Suk Ko, Cheol Lee, Ki Heon Nam, Kang Hoon Ko, Jong Deuk Rha; J Korean Soc Fract 2001;14(4):677-684. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.677

Abstract PDF: PURPOSE
To investigate the indication of transfixation of distal tibiofibular syndesmosis.
MATERIALS AND METHODS
Twenty-two patients were surgically treated for diastasis of the distal tibiofibular syndesmosis and followed for more than one year. The decision to transfix the syndesmosis was made according to the result of intraoperative stress test.
RESULTS
In patients with bimalleolar fracture, good or excellent clinical results were obtained in all patients, and no widening of the medial clear space and I mm or no widening of the tibiofibular clear space was observed. In patients with deltoid ligament tear, good or excellent results were obtained in five patients, and the medial clear space was widened more than 1mm in three patients and tibiofibular clear space was widened 2mm or more in four patients.
CONCLUSION
We believe that transyndesmotic fixation is not required if anatomical bimalleolar fracture fixation is achieved, and in patients who have deltoid ligament rupture, it may be better to transfix the syndesmosis regardless of the level of fibular fracture.

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Treatment of Unstable Intertrochanteric Fractures of the Femur - Comparative analysis of the postero-medial fixation with or without additional screw -: Jin Hong Ko, Bum Gu Lee, Do Hyun Moon, Young Sung Kim; J Korean Soc Fract 1998;11(3):487-494. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.487

Abstract PDF: An unstable intertrochanteric fracture lacks continuity of the bone cortex on the opposing surfaces of the proximal and distal fragments. This cortical deficit is due to either comminuti- On on the medial aspect of the neck(calcar-region) or a large and separate posterior trochan-teric fragment. Treatment of unstable intertochanteric fracture have taken method to restore bony contact medially and posteriorly by anatomical reduction or displacement osteotomy. The authors analyzed the 60 unstable intertrochanteric fractures treated by anatomic reduction and internal fixation with a compression hip screw from January 1990 to December 1995. We made a comparative analysis of the postero-medial fixation with additional screw(Group I) and no fixation group(Group II). We tried to find the difference of operation time, blood loss, union time, weight bearing time, neck-shaft angle, sliding length of lag screw and complication rate in two groups. The results were obtained as follows: 1. The mean union time was 11.5 weeks in the Group I and 12.7 weeks in the Group II (p>0.05). 2. The mean weight bearing time was 6.1 weeks in the Group I and 8.3 weeks in the Group II (p<0.05). 3. The decrease of neck-shaft angle was 2.3 degree in the Group I and 5.2 degree in the Group II(p<0.05). 4. The sliding length of lag screw was 5.8mm in the group I and 11.2mm in the group II(p< 0.05). 5. The lower complication rate was obtained in the group I than in the Group II, but two groups showed no significance by statistical analysis. In conclusion, the postero-medial fixation with additional screw in the treatment of unstable intertrochanteric fracture of the femur are suggested that medial cortical stability can be gained and early weight-bearing can be allowed.

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A Clinical Study of the Ankle Fracture with Diastnsis: Ik Dong Kim, Jo Chul Ihn, Pong Tnk Kim, Byung Chul Park, Young Goo Lyu, Il Hyung Park, Chang Hyuk Choi; J Korean Soc Fract 1992;5(2):253-259. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.253

Abstract PDF: The ankle fracture with diastasls of distal tibiofibular joint is caused by an axial loading force with concomitant external rotation and associated with severe ankle fracture in addition to talai subluxation due to rupture of the distal tibiofibular syndesmosis. In order to restore the normal ankle mortise, operative anatomical reduction and temporary stabilization of the syndesmosis is mostily required until early ligament healing is present. Twelve cases among ninety-six cases of the ankle fracture were associated with diastasis and treated in the Department of Orthopedic Surgery, Kyungpook National University Hospital during the period from January, 1988 to May, 1991. We analysed these cases according to injury mechanism, radiographic criterion, the patterns of associated medial and lateral injury and treatment result. The results obtained were as follows; 1. The incidence of trauma was most frequent in 5th decade(5 cases). 2. Diastasls was produced by 3 mechanism according to Lauge-Hansen classification : (pronalion-external rotation : 7, Suplnatlon-external rotation : 3, pronation-Abduction;2). 3. All were associated with fibular fracture : proximal fibular fracture was most common (7cases). 4. All had disruption of the medial structures (medial ligament rupture 3, medial malleolusfracture 9). 5. Although the cases were small, there seems no significant differences between transfixation group and unfixation group when accurate anatomical restoration of the distal tibiofibular syndesmosis was achieved.

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