OPERATIVE THERAPY OF MALLEOLAR FRACTURE WITH DISTAL TIBIOFIBULAR ARTICULATION DAMAGE. STATIC AND DYNAMIC FIXATION OF TIBIOFIBULAR SYNDESMOSIS, COMPARISON OF RESULTS

Introduction: a dynamic system for fixation of distal tibiofibular articulation damages in recent times cut a swath among experts in traumatology and orthopedicsarea since at a high frequency of occurrence of such damage its classical static fixation by position screw has a number of disadvantages with consequent complica-tions. A dynamic fixation provides physiologic micromotion intercostal articulation with maintenance of adequate repositioning that assumes its advantage over static fixation.a e-mail: Fedor_lazko@mail.rub e-mail: Semeonoff.aleks2011@yandex.ruc e-mail: Okneller90@gmail.comd e-mail: Ramidisser@mail.rue e-mail: Dr.Romanov67@mail.ruf e-mail: Pauldemon94@gmail.comstudy purpose: comparison of clinical and radiological results of static and dynamic fixation methods of the distal tibiofibular articulation instability.Methods: Was carried out an effectiveness analysis of treatment of 42 patients having B and C-types malleolar fractures according to AO/ASIF classification withtibiofibular syndesmosis damage, in settings of the traumatology and orthopedic department of the State Clinical Hospital No. 67 named after Vorokhobov duringthe period from 2016 to 2018. Patients were divided into two groups depending on the type of syndesmosis fixation: 21 patients were included into dynamic fixation group and 21 patients were included into static fixation group. Control examinations were carried out at 1.5; 3; 6 and 12 months after surgery. The average follow-up period was 12 months. Clinical and x-ray methods were used, scores questionnaires were filled in (AOFAS, FADI, OMAS).study results: evaluation of the obtained data showed that tendency to better clinical and radiologic results is reported in the dynamic fixation group.Conclusion: the dynamic fixation of distal tibiofibular articulation damages is a good alternative to its classical static fixation by position screw.

синдесмоз, травма голеностопного сустава, перелом лодыжек, позиционный винт, syndesmosis, ankle joint injury, malleolar fracture, position screw

1. Котельников Г.П., Краснов А.Ф., Мирошниченко В.Ф. Трав- матология: учебник. - 3-е изд., перераб. и доп. - М.: ООО «Медицин- ское информационное агентство», 2009. - 536 с: ил

2. Саймон Р.Р., Шерман С.С., Кенингснехт С.Дж. Неотложная травматология и ортопедия. Верхние и нижние конечности/ Пер. с англ. - М.; СПб: «Издательство БИНОМ» - «ИзДАТЕЛьСТВО «ДИ- АЛЕКТ», 2014. - 576 с., 680 ил

3. АО - Принципы лечения переломов. В 2 т. Т. 2. частная трав- матология / под ред. Томас П. Рюди, Ричард э. Бакли, Кристофер Г. Мо- ран; пер. с англ. Ситник А. - Изд. 2-е переработанное и дополненное Минск: «ВассаМедиа», 2013

4. Dattani R., Patnaik S., Kantak A., Srikanth B., Selvan T.P. In- juries to the tibiofibular syndesmosis. J Bone Joint Surg Br. 2008; 90(4): S. 405-410

5. Kim J.H., Gwak H.C., Lee C.R., Choo H.J., Kim J.G., Kim D.Y. A comparison of screw fixation and suture-button fixation in a Syndesmo- sis injury in an ankle fracture. J Foot Ankle Surg. 2016; 55(5): S. 985-990

6. Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012; 36(6): S. 1199-1206

7. Kocadal O., Yucel M., Pepe M., Aksahin E., Aktekin C.N. Evalua- tion of reduction accuracy of suture-button and screw fixation techniques for Syndesmotic injuries. Foot Ankle Int. 2016; 37(12): S. 1317-1325

8. Schepers T., Van Lieshout E.M., Hj VDL, De Jong V.M., Goslings J.C. Aftercare following syndesmotic screw placement: a systematic review. J Foot Ankle Surg. 2013; 52(4): S. 491-494

9. Mp VDB, Kloen P., Luitse J.S., Raaymakers E.L. Complications of distal tibiofibular syndesmotic screw stabilization: analysis of 236 patients. J Foot Ankle Surg. 2013; 52(4): S. 456-459

10. Magan A., Golano P., Maffulli N., Khanduja V. Evaluation and management of injuries of the tibiofibular syndesmosis. Br Med Bull. 2014; 111(1): S.101-115

11. Xu G., Chen W., Zhang Q., Wang J., Su Y., Zhang Y. Flexible fixa- tion of syndesmotic diastasis using the assembled bolt-tightrope system. Scand J Trauma Resusc Emerg Med. 2013; 21(1): S. 71

12. Kortekangas T., Savola O., Flinkkila T., Lepojarvi S., Nortunen S., Ohtonen P., et al. A prospective randomized study comparing Tight- Rope and syndesmotic screw fixation for accuracy and maintenance of syn- desmotic reduction assessed with bilateral computed tomography. Injury. 2015; 46(6): S.1119-1126

13. Laflamme M., Belzile E.L., Bédard L., Van Den Bekerom MPJ, Glazebrook M., Pelet S. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma. 2015; 29(5): S. 216-223

14. Egol K, Pahk B, Walsh M, Tejwani N, Davidovitch R, Koval K. Outcomes after unstable ankle fracture: Effect of syndesmotic stabilization. J Orthop Trauma. 2010; 11; 24(1): S.7-11

15. Van den Bekerom MPJ, Hogervorst M., Bolhuis H.W., van Dijk C.N. Operative aspects of the syndesmotic screw: Review of current con- cepts. Injury. 2008; 39(4): S.491-8

16. Seitz WJ, Bachner E., Abram L., Postak P., Polando G., Brooks D., et al. Repair of the tibiofibular syndesmosis with a flexible implant. J Orthop Trauma. 1991; Jan.: S.78-82

17. Miller R., Weinhold P., Dahners L. Comparison of tricortical screw fixation versus a modified suture construct for fixation of ankle syndesmo- sis injury: a biomechanical study. J Orthop Trauma. 1999; Jan.: S.39-42

18. Thornes B., Walsh A., Hislop M., Murray P., O’Brien M. Suture- endobutton fixation of ankle tibio-fibular diastasis: a cadaver study. Foot Ankle Int. 2003; Feb.: S.142-6

19. Soin S.P., Knight T.A., Dinah A.F., Mears S.C., Swierstra B.A., Belkoff S.M. Suture-Button Versus Screw Fixation in a Syndesmosis Rupture Model: A Biomechanical Comparison. Foot Ankle Int. 2009; 30(04): S.346-52

20. Klitzman R., Zhao H., Zhang L-Q., Strohmeyer G., Vora A. Suture-Button Versus Screw Fixation of the Syndesmosis: A Biomechanical Analysis. Foot Ankle Int. 2010; 31(01): S. 69-75