gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2019)

22. - 25.10.2019, Berlin

The impact of preoperative bilateral CT of syndesmosis’ injuries on the patients’ Health Related Quality of Life (HRQoL) in Weber B and C fractures

Meeting Abstract

  • presenting/speaker Davide Bizzoca - University of Bari - SMBNOS, Orthopaedic Unit, Bari, Italy
  • Giovanni Vicenti - University of Bari - SMBNOS, Orthopaedic Unit, Bari, Italy
  • Massimiliano Carrozzo - University of Bari - SMBNOS, Orthopaedic Unit, Bari, Italy
  • Biagio Moretti - University of Bari - SMBNOS, Orthopaedic Unit, Bari, Italy

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocIN18-189

doi: 10.3205/19dkou709, urn:nbn:de:0183-19dkou7093

Published: October 22, 2019

© 2019 Bizzoca et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objectives: This study aims to compare the Health-Related Quality of Life (HRQoL) at 24-months follow-up in patients who underwent stabilization of syndesmosis with one tricortical syndesmotic screw, randomized into 2 different groups: Group A with preoperative fractured CT scan, and Group B with preoperative bilateral ankle CT analysis.

Methods: The study was approved by our Institutional Board. Patients between 20 and 65 years of age with ankle fracture OTA/AO 44-B and 44-C, with a concomitant injury of the syndesmosis, were recruited. Exclusion criteria were: open fracture, previous injury to the lower extremities, ankle osteoarthritis, medical illness precluding participation in the follow-up examination. Patients were randomized in two different groups: Group A received preoperative CT scan of the fractured ankle; Group B patients underwent preoperative bilateral ankle CT scan. All the patients received the postoperative CT scan of both ankles. Patients were followed clinically and radiographically at 3-, 6- 12- and 24-months postoperatively. The main outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the Short-Form 36 questionnaire (SF-36) In CT scans, to identify the anatomic distal tibiofibular relationship, we evaluate a series of 7 measurements on axial CT scan images according to Nault et al. (Figure 1 [Fig. 1]).

Statistical analysis was performed with SPSS v25.0 (SPSS Inc., Chicago, IL, USA). The Shapiro-Wilk Tess, the unpaired T-test and the Pearson correlation test were performed. The tests were two-tailed with a confidence level of 5%.

Results and conclusion: 58 patients (26 males; 32 females; mean age: 43.6) were randomized into two groups: 29 patients in Group A and 29 in Group B. Post-operative CT showed a better restoration of the tibiofibular distances and the correct ankle anatomy in Group B compared with Group A. Two patients had a superficial infection of the wound managed with oral antibiotics. We registered 5 cases of broken screws: 2 in Group B, 3 in Group A. At 24-months follow-up, the mean AOFAS and SF-36 score were significantly higher in Group B, compared with Group A (p=0.002; p=0.0055). A negative correlation was found, at 24 months follow-up, between mean AOFAS score and ΔC length (p=0.0033). This study confirms the preoperative bilateral ankle CT scan is a useful tool, in the management of ankle fractures with a concomitant syndesmotic injury. The restoration of the ankle anatomy seems to significantly impact on the patients' HRQoL. Future trials and cadaveric studies are necessary to identify the „golden rule“ for the ideal angle of the syndesmotic screw placement.