Postoperative Syndesmotic Widening Following Ankle Fracture Fixation: A Retrospective Comparison of Fibular Nailing and Plating.

Abstract

Disruption of the distal tibiofibular syndesmosis is a common complication of ankle fractures that can result in chronic instability and early osteoarthritis. This study aimed to compare syndesmotic widening and complications after plate fixation versus intramedullary fibular nailing. We hypothesized that fibular nailing would be associated with more syndesmotic widening but fewer complications. Patients treated with plate or nail fixation for ankle fractures at a level 1 trauma center were identified through query of the electronic medical record. Data included demographics, fracture characteristics, medial clear space (MCS), tibiofibular clear space (TFCS), and complications. Mortise radiographs were assessed preoperatively, intraoperatively, and postoperatively. Syndesmotic widening was defined as MCS >4 mm and TFCS >5 mm at final follow-up. A total of 143 ankles were included; 84 patients (58.7%) received plate fixation, and 59 patients (41.3%) received fibular nailing. Mean follow-up was 6.1 ± 4.1 months and 6.5 ± 5.3 months, respectively. With the number of patients available, no significant differences were found between cohorts in the change in MCS (<i>P</i> = .663) or TFCS (<i>P</i> = .912) from fluoroscopy to 6 months postoperatively. No significant difference was observed in the proportion of patients with MCS >4 mm (<i>P</i> = .163) or TFCS >5 mm (<i>P</i> = .087) at final follow-up. Complication rates did not significantly differ between cohorts (20.2% plate cohort vs 16.9% nail cohort; <i>P</i> = .621). Syndesmotic widening after ankle fracture fixation is comparable between plating and fibular nailing, suggesting both methods effectively maintain syndesmotic reduction.