Syndesmotic Ankle Fractures: A Systematic Review

James D. Michelson, Michael Wright, Michael Blankstein

Research output: Contribution to journalArticlepeer-review


OBJECTIVES:: The diagnosis and treatment of syndesmotic ankle fractures is controversial. This systematic review was performed to clarify the current understanding addressing several clinical questions that arise in the treatment of such injuries DATA SOURCES:: The English language literature was searched using PubMed, EMBASE, and Web of Science. The search terms were “syndesmosis” or “syndesmotic” in combination with the terms “ankle fracture” or “fracture”. The included dates were between 1967 and July 2015. STUDY SELECTION:: Inclusion criteria were: number of patients >20, patient age > 18 years, follow up > 1 year, ankle fracture classification was reported, criteria for surgery was reported, technique of surgery was reported, and a validated outcome measure was used. Studies limited to biomechanical or imaging investigations were excluded. DATA EXTRACTION:: Information was abstracted using a standardized template, which encompassed the inclusion criteria together with the study type, post-operative regimen, and complications. Study quality was evaluated using the modified CONSORT statement and Coleman criteria. Study bias was assessed and methodologic quality was rated. Any differences in ratings were resolved by consensus. DATA SYNTHESIS:: None CONCLUSIONS:: The overall quality of the studies was poor. The number or placement of syndesmotic screws or the breakage of trans-syndesmotic screws post-operatively had no adverse effect on outcomes (both with Moderate Strength of Evidence). The use of alternative fixation devices (bioabsorbable, endo-button) had Poor Strength of Evidence, as did the opinion that non-displaced, unstable by stress-test, syndesmotic injuries required fixation. There is insufficient data that links subtle rotational syndesmotic malreduction to clinical outcomes

Original languageEnglish (US)
JournalJournal of Orthopaedic Trauma
StateAccepted/In press - Jun 22 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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