Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 1;36(9):469-473.
doi: 10.1097/BOT.0000000000002356.

Syndesmotic Injury in Tibial Plafond Fractures Is Associated With Worse Patient Outcomes

Garrett V Christensen  1 , John C Wheelwright, David L Rothberg, Thomas F Higgins, Lucas S Marchand, Justin M Haller
Affiliations

Syndesmotic Injury in Tibial Plafond Fractures Is Associated With Worse Patient Outcomes

Garrett V Christensen et al. J Orthop Trauma. .

Abstract

Objectives: To present long-term patient-reported outcomes of tibial plafond fractures with and without concomitant ankle syndesmotic injury.

Design: Retrospective cohort study.

Setting: Academic Level 1 trauma center.

Patients/participants: One hundred ninety-seven patients with tibial plafond fractures (OTA/AO 43-B and 43-C) treated with definitive surgical fixation were contacted by telephone or email to obtain patient-reported outcome scores at a minimum follow-up of 1 year. Of those contacted, 148 (75%) had an intact syndesmosis, whereas 49 (25%) experienced a syndesmotic injury.

Intervention: The intervention involved open reduction internal fixation of the tibial plafond with syndesmosis repair when indicated.

Main outcome measurement: The main outcome measurement included patient-reported ankle pain and function using Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function (PF).

Results: The cohort including patients with syndesmotic injury had significantly more open fractures (syndesmotic injury = 39%, no syndesmotic injury = 16%, P = 0.001), higher rates of end-stage reconstruction (syndesmotic injury = 27%, no syndesmotic injury = 10%, P = 0.004), and worse PROMIS PF (syndesmotic injury = 42.5 [SD = 8.0], no syndesmotic injury = 47.1 [SD = 9.6], P = 0.045) scores at final follow-up when compared with the cohort comprising patients with no syndesmotic injury. Patients with syndesmotic injury trended toward higher rates of postoperative infection, but this association was not statistically significant. There was no difference between the groups in nonunion or PROMIS pain interference scores.

Conclusion: Patients with a tibial plafond fracture and concomitant syndesmotic injury had significantly worse PROMIS PF scores, more end-stage ankle reconstructions, and more open fractures. Syndesmotic injury in the setting of tibial plafond fractures portends worse patient outcomes.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

T. F. Higgins is a paid consultant for DePuy, Globus Medical, and Imagen; receives intellectual property royalties from DePuy; has stock or stock options in NT nPhase, Orthogrid, and Osteocentric; and is a board or committee member for the Orthopaedic Trauma Association. J. M. Haller is a paid consultant for NewClip Technics, Osteocentric, and Stryker and is a board or committee member for the Western Orthopaedic Association and the Orthopaedic Trauma Association. The remaining authors have report no conflict of interest.

References

    1. Marsh JL, Weigel DP, Dirschl DR. Tibial plafond fractures. How do these ankles function over time? J Bone Joint Surg Am. 2003. Feb;85(2):287–95. - PubMed
    1. Haller JM, Holt D, Rothberg DL, et al. Does early versus delayed spanning external fixation impact complication rates for high-energy tibial plateau and plafond fractures? Clin Orthop Relat Res. 2015;474:1436–1444. - PMC - PubMed
    1. Duckworth AD, Jefferies JG, Clement ND, et al. Type C tibial pilon fractures: short- and long-term outcome following operative intervention. Bone Joint J. 2016;98-B:1106–1111. - PubMed
    1. De-Las-Heras-Romero J, Lledo-Alvarez AM, Lizaur-Utrilla A, et al. Quality of life and prognostic factors after intra-articular tibial pilon fracture. Injury. 2017. Jun;48(6):1258–1263. - PubMed
    1. Minator Sajjadi M, Ebrahimpour A, Okhovatpour MA, et al. The Outcomes of Pilon Fracture Treatment: Primary Open Reduction and Internal Fixation Versus Two-stage Approach. Arch Bone Jt Surg. 2018. Sep;6(5):412–419. - PMC - PubMed

Publication types