Dynamic method of fixation of the tibia in case of damage to the tibiofibular syndesmosis

Abstract: For today, the methods of fixation of the tibiofibular syndesmosis are represented by a positional screw and a Tight Rope system. These methods of fixation are designed for the safe conduct of full-fledged rehabilitation measures in the early postoperative period.
The purpose: to search for a functionally dynamic fixator of tibiofibular syndesmosis to reduce the treatment time of patients.
Material and methods: 270 people underwent surgery in the period from 2019 to 2022. 260 people were included in the study. A partial-threaded screw was installed in all patients as a fixator of tibiofibular syndesmosis. The follow-up was on 0.5; 1.5; 3; 6 and 12 months after surgery. The results were evaluated according to the AOFAS, VAS and OMAS scales.
Results: The rapid dynamics of recovery of ankle joint function were noted. After 2 weeks from surgery, the average AOFAS value was 80.2 points, and after 1.5 months 92.4 points. The average value of VAS was 2-4 points. The average OMAS value it was 90.5 and 100.3 after 1.5 and 3 months, respectively. Screw failure was recorded in 4 patients (1.5%) between 6 and 12 months after surgery without secondary tibial divergence.
Conclusion: the use of a partially threaded screw significantly reduces the risk of mechanical failure of fixation during active rehabilitation of patients from the earliest stages of the postoperative period, and there is no need for stage-by-stage removal of the screw in a regulated time.

1. Bekker Yu.N., Klassifikatsiya metodov fiksatsii distal’nogo mezhbertsovogo sindesmoza Kafedra travmatologii i ortopedii. 2016;Spetsvypusk:30.

2. Hamid K.S., Glisson R.R., Morash J.G., Matson A.P., DeOrio J.K., Simultaneous Intraoperative Measurement of Cadaver Ankle and Subtalar Joint Compression During Arthrodesis With Intramedullary Nail, Screws, and Tibiotalocalcaneal Plate. Foot Ankle Int. 2018;39(9):1128–1132. DOI: 10.1177/1071100718774271

3. Drogin A.R., Semenov A.Yu., Kneller L.O., Borgkhut R.D., Romanov D.A., Comparing the efficiency of treatment in cases of distal tibiofibular syndesmosis with the use of position screw and button fixator (literature review) Kafedra travmatologii i ortopedii. 2018;2:39-45. DOI: 10.17238/issn2226-2016.2018.2.39-45]

4. Kozhemyaka M.A., Golovakha M.L., Panchenko S.P., Shevelev A.V., Modeling of tibia and fibula fixation with tensioned loops in cases of injuries to the tibiofibular syndesmosis Orthopaedics, Traumatology and Prosthetics. 2015;3:27-35. DOI: 10.15674/0030-59872015327-35

5. van der Eng D.M., Schep N.W., Schepers T., Bioabsorbable Versus Metallic Screw Fixation for Tibiofibular Syndesmotic Ruptures: A Meta-Analysis J. Foot Ankle Surg. 2015;54(4):657–662. DOI: 10.1053/j.jfas.2015.03.014

6. Golubev V.G., Zelenyak K.B., Starostenkov A.N., Bioabsorbable implants in treatment of ankle fractures (comparative study) Kafedra travmatologii i ortopedii. 2018;2:66-73. DOI: 10.17238/issn2226-2016.2018.2.66-73

7. Kneller L.O., Zagorodnii N.V., Lazko F.L., Semenov A.Yu., Borgkhut R.D., Romanov D.A., Klinicheskii opyt primeneniya dinamicheskogo metoda fiksatsii mezhbertsovogo sindesmoza pri ego povrezhdenii Travma 2018: mul’tidistsiplinarnyi podkhod. 2018:140-141

8. Stiene A., Renner C.E., Chen T., Liu J., Ebraheim N.A., Distal Tibiofibular Syndesmosis Dysfunction: A Systematic Literature Review of Dynamic Versus Static Fixation Over the Last 10 Years J. Foot Ankle Surg. 2019;58(2):320-327. DOI: 10.1053/j.jfas.2018.08.050

9. Rigby R.B., Cottom J.M., Does the Arthrex TightRope® provide maintenance of the distal tibiofibular syndesmosis? A 2-year follow-up of 64 TightRopes in 37 patients J. Foot Ankle Surg. 2013;52(5):563–567. DOI: 10.1053/j.jfas.2013.04.013

10. Becker Y.N., Mitroshin A.N., Lemin M.S., Nesterov S.A., Modeling and design of dynamic lock to restore of the distal tibiofibular syndesmosis The Department of Traumatology and Orthopedics. 2015;4(16):12-19

11. Buckley R.E., Moran G.C., AO Principles of Fracture Management: in 2 vol. 3rd ed. Davos. 2019;2:955-959. DOI: 10.1055/b-006-149767

12. Khoroshkov S.N., Funktsional’noe operativnoe lechenie perelomov lodyzhek s povrezhdeniem distal’nogo mezhbertsovogo sindesmoza Sovremennye metody diagnostiki i lecheniya zabolevanii i povrezhdenii oporno-dvigatel’nogo apparata. Khirurgiya povrezhdenii mirnogo vremeni. 2018:84-85

13. Bogatskii G.V., Fain A.M., Vaza A.Yu., Gnetetskii S.F., Grandelis A., Research of functional mobility in tibiofibular syndesmosis and its changes under fixation of various implants (experimental research)] Prakticheskaya meditsina. 2021;19;3:20-23. DOI: 10.32000/2072-1757-2021-3-20-23

14. Kneller L.O. Dynamic method of tibiofibular syndesmosis injuries fixation in malleolar fracture Discertatsiya kandidata meditsinskikh nauk. Moskva. 2018:87-97

15. Method for the treatment of ankle fractures associated with damage to the tibiofibular syndesmosis: patent 2793720 Ros. Federatsiya № 2022117941; zayavl. 01.07.2022; opubl. 05.04.2023, Byul. № 10

16. Semenistyi A.Yu. Operative treatment and rehabilitation of the patients with ankle fractures Discertatsiya kandidata meditsinskikh nauk. Moskva. 2005:5-15