OUTCOMES FOLLOWING DYNAMIC SYNDESMOTIC FIXATION IN ANKLE FRACTURES WITH A SYNDESMOTIC INJURY: A RETROSPECTIVE COHORT STUDY FROM SOUTH AFRICA.

Ebrahim Peer; Robert Francis Snyders; Johannes Lodewicus Pretorius

doi:10.51168/sjhrafrica.v6i6.1708

Authors

Dr. Ebrahim Peer MBChB (UKZN), Registrar, Department of Orthopaedic Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Dr. Robert Francis Snyders MBChB (Stell), FC Orth (CMSA), MMed Orth (UKZN), Head Clinical Unit, Department of Orthopaedic Surgery, Addington Hospital; Honorary Lecturer, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Dr. Johannes Lodewicus Pretorius MBChB (Stell), FC Orth (CMSA), MMed Orth (UKZN), Consultant Orthopaedic Surgeon, Addington Hospital; Honorary Lecturer, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1708

Keywords:

ankle fracture, syndesmosis, syndesmotic fixation, dynamic fixation, static screw fixation, tightrope

Abstract

Background

Ankle fractures are common injuries, with approximately 33% involving syndesmotic disruption in South Africa. While static screw fixation (SSF) has traditionally been the standard treatment, dynamic fixation (DF) using suture-button devices offers an increasingly popular alternative. This study evaluated the clinical outcomes of DF in managing syndesmotic injuries.

Materials and Methods

A retrospective cohort study was conducted on 50 patients who sustained ankle fractures with associated syndesmotic injuries and underwent surgical fixation using suture-button devices at a regional hospital in KwaZulu-Natal. Outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score at a one-year follow-up.

Results

The mean age of patients was 36.9 years, and 70% were female. Most injuries were classified as Weber B and SER stage 4. All patients achieved fracture union and maintained syndesmotic reduction, with no malreductions, infections, or hardware failures reported. The mean AOFAS score was 91.7, with 92% of patients scoring above 75. Higher BMI (p = 0.019) and delayed surgery beyond 14 days (p = 0.002) were associated with lower scores. HIV-positive patients had slightly reduced scores, although this was not statistically significant. Smoking and elevated BMI did not increase complication rates. Functional outcomes were comparable between single and double suture-button fixation (p = 0.1).

Conclusion

Dynamic syndesmotic fixation using suture-button devices is a safe and effective method for treating syndesmotic injuries, with excellent short-term functional outcomes and low complication rates. Patient-specific factors, including BMI and surgical timing, significantly influence recovery, highlighting the need for individualized care.

Recommendation

Given the favorable outcomes and reduced complication profile, dynamic fixation should be considered a preferred treatment strategy for syndesmotic injuries, particularly in young, active patients. Further prospective studies are warranted to confirm long-term efficacy and guide broader implementation.

Author Biographies

Dr. Robert Francis Snyders, MBChB (Stell), FC Orth (CMSA), MMed Orth (UKZN), Head Clinical Unit, Department of Orthopaedic Surgery, Addington Hospital; Honorary Lecturer, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Dr Robert Francis Snyders
• MB,ChB (Stel), FC Orth (CMSA), MMED Orth (UKZN)
• Head Clinical Unit Orthopaedics Addington Hospital, 13 Erskine Terrace, South
Beach, Durban, 4001, South Africa
• ORCID number: 0009-0003-2286-1792
• Robert.Snyders@kznhealth.gov.za

Dr. Johannes Lodewicus Pretorius, MBChB (Stell), FC Orth (CMSA), MMed Orth (UKZN), Consultant Orthopaedic Surgeon, Addington Hospital; Honorary Lecturer, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Dr Johannes Lodewicus Pretorius
• MB,ChB (Stel), FC Orth (CMSA), MMED Orth (UKZN)
• Orthopaedics Consultant Addington Hospital, 13 Erskine Terrace, South Beach,
Durban, 4001, South Africa
• ORCID number: 0009-0008-5716-6198
• johan.doc@gmail.com

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