The Australian ankle syndesmosis injury survey.

Abstract

The ankle syndesmosis is frequently disrupted in ankle injuries, with higher incidence in concomitant ankle fractures. There is debate regarding the most appropriate surgical management of these injuries, with the development of suture-button devices challenging the conventional approach of surgical stabilisation with syndesmotic screws. The primary aim of this study was to assess current practice variation at a national level, enabling a comparison with reported practice around the world. The secondary aims were to assess practice variation between operative indications and inconsistencies between surgeon device usage and personal preference should they be injured themselves. A 20-item survey detailing surgical experience, diagnosis, surgical management preference and a series of case studies was conducted. The survey was endorsed and promoted by the Australian Orthopaedic Association (AOA). 125 responses were received during the three-month study period. The most commonly used method to stabilise a syndesmotic injury by Australian orthopaedic surgeons was two 3.5 mm screws (26.4%), closely followed by one suture-button (23.2%). Overall, 44% of surgeons employ a dynamic stabilisation method and 54.4% a static stabilisation method. Half of surgeons recommend routine removal of syndesmosis screws, and surgeons tend to use two devices for high Weber C fractures. One third of surgeons who most commonly use screws in their practice would actually prefer a suture-button for management of their own syndesmosis injury. Significant variability remains in the management of syndesmosis injuries. This survey of Australian orthopaedic surgeons reveals higher suture-button device use when compared to other countries.