Abstract

Purpose

Patients with primarily ligamentous injuries of the distal tibiofibular joint comprise up to 12% of all ankle sprains. Patients frequently present late after a syndesmosis injury and delayed treatment potentially leads to pain, prolonged disability and arthritis in the long term. This study aimed to assess clinical outcomes in patients who required syndesmosis fixation in the presence of arthroscopically proven instability, the hypothesis being that a delay to treatment would be associated with worse function.

Method

A retrospective cohort study was performed of patients with dynamic instability requiring fixation between the years of 2010–2016. The procedures were performed by two foot and ankle fellowship trained orthopaedic surgeons, over three hospital sites. Patients were classified into three groups based on the time since injury to surgery, acute syndesmotic injury (< 6 weeks), sub-acute (6 weeks–6 months) and chronic syndesmotic injury (> 6 months). Functional scores were retrospectively collected using the Foot and Ankle Outcome Score (FAOS).

Results

Compared to patients with acute injuries, those with chronic injuries had significantly lower FAOS subscales (p < 0.001), with the greatest difference in quality of life (− 20.7, 95% CI − 31.6 to − 9.8, p = 0.012). There was a mean follow-up of 4.3 years. Although the average FAOS subscales in those with sub-acute injuries were lower than in those with acute injuries, the difference was not statistically significant.

Conclusion

The results of this study suggest that delayed surgical stabilisation (> 6 months) is associated with significantly worse clinical function, and thus timely identification and early referral of those patients with potentially unstable syndesmotic injuries is recommended.

Level of evidence

Level III.

中文翻译：

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动态不稳定的皮下联合损伤的稳定延迟导致功能恶化。

摘要

目的

胫腓骨远端韧带损伤的患者占所有踝关节扭伤的12％。从长远来看，患者常在下颌关节损伤后出现，并且延迟治疗可能导致疼痛，长期残疾和关节炎。这项研究旨在评估在经关节镜证实的不稳定性的情况下需要进行结节固定术的患者的临床结局，其假设是治疗延迟与功能恶化有关。

方法

对2010年至2016年间需要固定的动态不稳定患者进行了一项回顾性队列研究。该程序由两名脚和踝关节研究员训练的整形外科医生在三个医院现场进行。根据自手术受伤以来的时间，急性下颌联合损伤（<6周），亚急性（6周至6个月）和慢性下颌联合损伤（> 6个月）将患者分为三类。使用脚和脚踝结果评分（FAOS）回顾性收集功能评分。

结果

与急性损伤患者相比，慢性损伤患者的FAOS量表明显较低（p  <0.001），生活质量差异最大（-20.7，95 ％CI-31.6至-9.8，p  = 0.012）。平均随访4。3年。尽管亚急性损伤患者的平均FAOS量表低于急性损伤者，但差异无统计学意义。

结论

这项研究的结果表明，手术稳定时间的延长（> 6个月）与临床功能的严重恶化有关，因此，建议对那些潜在不稳定的双下皮损伤患者进行及时的识别和早期转诊。

证据水平

第三级。