Comparison of bioabsorbable screw and metallic screw for Maisonneuve fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEN Xiaodong , LU Jun , ZHAO Hongmou , LI Yi , CHANG Xin , ZHANG Yan , LIANG Jingqi ,  LIANG Xiaojun

Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

LIANG Xiaojun, Email: liangjun33369@163.com

Keywords：

Absorbable screw; metallic screw; Maisonneuve fracture; open reduction; internal fixation

DOI：

10.7507/1002-1892.201908118

Video：

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Objective To compare the clinical and radiographic outcomes of bioabsorbable screw and metallic screw for Maisonneuve fracture.Methods The clinical data of 68 patients of Maisonneuve fracture treated with open reduction and internal fixation between October 2012 and October 2016 were retrospectively analyzed. Metallic screw fixation was used in 37 cases (group A) and absorbable screw fixation was used in 31 cases (group B). There was no significant difference in age, gender, weight, operated side, cause of injury, time from injury to operation, and complications between the two groups (P>0.05). At last follow-up, the tibiafibular clear space (TFCS), tibiafibular overlap (TFO), medial clear space (MCS), and syndesmotic malreduction rate were recorded. And the dorsiflexion and plantar-flexion range of motion, pain visual analogue scale (VAS) score, ankle and hind foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and Olerud-Molander (OM) score were recorded.Results All patients were followed up 25-43 months, with an average of 32.3 months. There was no significant difference in the operation time between the two groups (t=1.229, P=0.282). All the fractures healed, and there was no significant difference in fracture healing time between the two groups (t=1.367, P=0.413). At last follow-up, the syndesmotic malreduction rate of group A was 16.2% (6/37), showing no significant difference when compared with group B [6.2% (2/31)] (χ²=1.549, P=0.213). There were 3 complications in group A, 1 was superficial wound infection, 1 was local heterotopic ossification due to failure to remove the screws in time, 1 was local heterotopic ossification of the screws; and there were 2 complications in group B, 1 was rejection and 1 was local heterotopic ossification of the screws. There was no significant difference in the incidence of complications between the two groups (χ²=0.068, P=0.794). There was no significant difference in TFCS, MCS, TFO, ankle dorsiflexion and plantar-flexion range of motion, AOFAS score, OM score, and VAS score between the two groups at last follow-up (P>0.05).Conclusion Compared with metallic screw, absorbable screws provide adequate fixation and functional recovery with avoiding screw removal and lower syndesmotic malreduction.

Citation： WEN Xiaodong, LU Jun, ZHAO Hongmou, LI Yi, CHANG Xin, ZHANG Yan, LIANG Jingqi, LIANG Xiaojun. Comparison of bioabsorbable screw and metallic screw for Maisonneuve fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 482-488. doi: 10.7507/1002-1892.201908118 Copy

1.	Duchesneau S, Fallat LM. The Maisonneuve fracture. J Foot Ankle Surg, 1995, 34(5): 422-428.
2.	李岳伟, 张茗慧, 李小荣, 等. 弹性固定及坚强固定治疗踝关节旋前-外旋型骨折合并下胫腓联合分离的疗效比较. 中国修复重建外科杂志, 2017, 31(7): 820-824.
3.	Stufkens SA, van den Bekerom MP, Doornberg JN, et al. Evidence-based treatment of maisonneuve fractures. J Foot Ankle Surg, 2011, 50(1): 62-67.
4.	Sun H, Luo CF, Zhong B, et al. A prospective, randomised trial comparing the use of absorbable and metallic screws in the fixation of distal tibiofibular syndesmosis injuries: mid-term follow-up. Bone Joint J, 2014, 96-B(4): 548-554.
5.	Xie Y, Cai L, Deng Z, et al. Absorbable screws versus metallic screws for distal tibiofibular syndesmosis injuries: A Meta-analysis. J Foot Ankle Surg, 2015, 54(4): 663-670.
6.	Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg, 2007, 15(6): 330-339.
7.	Gardner MJ, Demetrakopoulos D, Briggs SM, et al. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int, 2006, 27(10): 788-792.
8.	Laflamme M, Belzile EL, Bédard L, et al. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma, 2015, 29(5): 216-223.
9.	Egol KA, Pahk B, Walsh M, et al. Outcome after unstable ankle fracture: effect of syndesmotic stabilization. J Orthop Trauma, 2010, 24(1): 7-11.
10.	Bartoníček J, Rammelt S, Kašper Š, et al. Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination. Arch Orthop Trauma Surg, 2019, 139(4): 497-506.
11.	Manyi W, Guowei R, Shengsong Y, et al. A sample of Chinese literature MRI diagnosis of interosseous membrane injury in Maisonneuve fractures of the fibula. Injury, 2000, 31: C107-C110.
12.	Merrill KD. The Maisonneuve fracture of the fibula. Clin Orthop Relat Res, 1993, (287): 218-223.
13.	Bissuel T, Gaillard F, Dagneaux L, et al. Maisonneuve equivalent injury with proximal tibiofibular joint dislocation: case report and literature review. J Foot Ankle Surg, 2017, 56(2): 404-407.
14.	Schepers T. Acute distal tibiofibular syndesmosis injury: asystematic review of suture-button versus syndesmotic screw repair. Int Orthop, 2012, 36(6): 1199-1206.
15.	Lambers KT, van den Bekerom MP, Doornberg JN, et al. Long-term outcome of pronation-external rotation ankle fractures treated with syndesmotic screws only. J Bone Joint Surg (Am), 2013, 95(17): e1221-e1227.
16.	Andersen MR, Frihagen F, Hellund JC, et al. Randomized Trial Comparing Suture Button with Single Syndesmotic Screw for Syndesmosis Injury. J Bone Joint Surg (Am), 2018, 100(1): 2-12.
17.	Teramoto A, Suzuki D, Kamiya T, et al. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med, 2011, 39(10): 2226-2232.
18.	Riedel MD, Miller CP, Kwon JY. Augmenting suture-button fixation for maisonneuve injuries with fibular shortening: technique tip. Foot Ankle Int, 2017, 38(10): 1146-1151.
19.	Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma, 2012, 26(7): 439-443.
20.	Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma, 2005, 19(2): 102-108.
21.	孙振辉, 陈宇, 张晖, 等. 解剖路径骨-韧带修复技术在旋前型踝关节骨折中的临床应用研究. 中国修复重建外科杂志, 2019, 33(11): 1351-1357.
22.	Cox S, Mukherjee DP, Ogden AL, et al. Distal tibiofibular syndesmosis fixation: a cadaveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation. J Foot Ankle Surg, 2005, 44(2): 144-151.
23.	Putnam SM, Linn MS, Spraggs-Hughes A, et al. Simulating clamp placement across the trans-syndesmotic angle of the ankle to minimize malreduction: A radiological study. Injury, 2017, 48(3): 770-775.
24.	张世权, 刘安庆, 肖德明, 等. 可吸收螺钉治疗踝关节骨折并发症分析. 中国骨与关节损伤杂志, 2006, 21(11): 921-922.
25.	Böstman O, Pihlajamäki H. Clinical biocompatibility of biodegradable orthopaedic implants for internal fixation: a review. Biomaterials, 2000, 21(24): 2615-2621.
26.	Ahmad J, Raikin SM, Pour AE, et al. Bioabsorbable screw fixation of the syndesmosis in unstable ankle injuries. Foot Ankle Int, 2009, 30(2): 99-105.

1. Duchesneau S, Fallat LM. The Maisonneuve fracture. J Foot Ankle Surg, 1995, 34(5): 422-428.
2. 李岳伟, 张茗慧, 李小荣, 等. 弹性固定及坚强固定治疗踝关节旋前-外旋型骨折合并下胫腓联合分离的疗效比较. 中国修复重建外科杂志, 2017, 31(7): 820-824.
3. Stufkens SA, van den Bekerom MP, Doornberg JN, et al. Evidence-based treatment of maisonneuve fractures. J Foot Ankle Surg, 2011, 50(1): 62-67.
4. Sun H, Luo CF, Zhong B, et al. A prospective, randomised trial comparing the use of absorbable and metallic screws in the fixation of distal tibiofibular syndesmosis injuries: mid-term follow-up. Bone Joint J, 2014, 96-B(4): 548-554.
5. Xie Y, Cai L, Deng Z, et al. Absorbable screws versus metallic screws for distal tibiofibular syndesmosis injuries: A Meta-analysis. J Foot Ankle Surg, 2015, 54(4): 663-670.
6. Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg, 2007, 15(6): 330-339.
7. Gardner MJ, Demetrakopoulos D, Briggs SM, et al. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int, 2006, 27(10): 788-792.
8. Laflamme M, Belzile EL, Bédard L, et al. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma, 2015, 29(5): 216-223.
9. Egol KA, Pahk B, Walsh M, et al. Outcome after unstable ankle fracture: effect of syndesmotic stabilization. J Orthop Trauma, 2010, 24(1): 7-11.
10. Bartoníček J, Rammelt S, Kašper Š, et al. Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination. Arch Orthop Trauma Surg, 2019, 139(4): 497-506.
11. Manyi W, Guowei R, Shengsong Y, et al. A sample of Chinese literature MRI diagnosis of interosseous membrane injury in Maisonneuve fractures of the fibula. Injury, 2000, 31: C107-C110.
12. Merrill KD. The Maisonneuve fracture of the fibula. Clin Orthop Relat Res, 1993, (287): 218-223.
13. Bissuel T, Gaillard F, Dagneaux L, et al. Maisonneuve equivalent injury with proximal tibiofibular joint dislocation: case report and literature review. J Foot Ankle Surg, 2017, 56(2): 404-407.
14. Schepers T. Acute distal tibiofibular syndesmosis injury: asystematic review of suture-button versus syndesmotic screw repair. Int Orthop, 2012, 36(6): 1199-1206.
15. Lambers KT, van den Bekerom MP, Doornberg JN, et al. Long-term outcome of pronation-external rotation ankle fractures treated with syndesmotic screws only. J Bone Joint Surg (Am), 2013, 95(17): e1221-e1227.
16. Andersen MR, Frihagen F, Hellund JC, et al. Randomized Trial Comparing Suture Button with Single Syndesmotic Screw for Syndesmosis Injury. J Bone Joint Surg (Am), 2018, 100(1): 2-12.
17. Teramoto A, Suzuki D, Kamiya T, et al. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries. Am J Sports Med, 2011, 39(10): 2226-2232.
18. Riedel MD, Miller CP, Kwon JY. Augmenting suture-button fixation for maisonneuve injuries with fibular shortening: technique tip. Foot Ankle Int, 2017, 38(10): 1146-1151.
19. Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma, 2012, 26(7): 439-443.
20. Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma, 2005, 19(2): 102-108.
21. 孙振辉, 陈宇, 张晖, 等. 解剖路径骨-韧带修复技术在旋前型踝关节骨折中的临床应用研究. 中国修复重建外科杂志, 2019, 33(11): 1351-1357.
22. Cox S, Mukherjee DP, Ogden AL, et al. Distal tibiofibular syndesmosis fixation: a cadaveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation. J Foot Ankle Surg, 2005, 44(2): 144-151.
23. Putnam SM, Linn MS, Spraggs-Hughes A, et al. Simulating clamp placement across the trans-syndesmotic angle of the ankle to minimize malreduction: A radiological study. Injury, 2017, 48(3): 770-775.
24. 张世权, 刘安庆, 肖德明, 等. 可吸收螺钉治疗踝关节骨折并发症分析. 中国骨与关节损伤杂志, 2006, 21(11): 921-922.
25. Böstman O, Pihlajamäki H. Clinical biocompatibility of biodegradable orthopaedic implants for internal fixation: a review. Biomaterials, 2000, 21(24): 2615-2621.
26. Ahmad J, Raikin SM, Pour AE, et al. Bioabsorbable screw fixation of the syndesmosis in unstable ankle injuries. Foot Ankle Int, 2009, 30(2): 99-105.

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Comparison of bioabsorbable screw and metallic screw for Maisonneuve fracture

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