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Syndesmosis Fixation 27829

 

synonyms: syndesmosis fixation

Syndesmosis Fixation CPT

Syndesmosis Fixation Indications

  • Syndesmosis instability after fixation of associated fractures.
  • Syndesmotic injury with diastasis or instability.

Syndesmosis Fixation Contraindications

  • Syndesmotic injury without diastasis or instability.

Syndesmosis Fixation Alternatives

  • Nonoperative treatment.

Syndesmosis Fixation Planning / Special Considerations

  • Fixation can be provided with two tricortical 3.5-mm screws or a 4.5-mm polylactide bioabsorbable screw, a 4.5mm stainless steel screw, or Arthrex tightropefixation. Tightrope fixation may have faster recovery without need for removal, ong term outcomes studies are currently lacking.
  • Consider the degree of instability and the size of the fibula when selecting screw size and determining the number of cortices engaged.
  • For high fibula fractures consider ORIF of the fibula to aid in determining proper rotation and length during syndesmotic fixation.
  • See also Arthrex Tightrope technique.

Syndesmosis Fixation Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Position the ankle in neutral. (Ankle position is controversial).
  • Reduce syndesmosis with a periarticular reduction forceps.
  • Centered drill on the fibula to avoid fracture.
  • Drill tricortical or quadcortical hole using standard AO technique 2-4cm proximal and parallel to the ankle joint in the coronal plane.
  • In the transverse plane, aim 25° to 30° obliquely from posterolateral to anteromedial because the fibula is located posterior to the tibia.
  • Place 4.5mm stainless steel, fully threaded screw using AO technique securing the syndesmosis. Do not insert screw in lag fashion.
  • Irrigate.
  • Close in layers.

Syndesmosis Fixation Complications

  • Instability
  • Broken hardware
  • Painful hardware
  • Pain
  • Arthritis
  • Infection
  • Instability, Broken hardware, Painful hardware, Pain, Arthritis, Infection

Syndesmosis Fixation Follow-up care

  • Post-op: place in NWB Bulky-Jones dressing with posterior mold and side splints.
  • 7-10 Days: Wound check. Place in NWB cast.
  • 6 Weeks: Cast removed, check xrays. Place in Cam-walker with slow progression to full weight bearing. Discontinue cam-walker if pain free after 4 weeks.
  • 3 Months: schedule for syndesmotic screw removal to be done 12weeks after placement.
  • 6 Months: Resume activities.

Syndesmosis Fixation Outcomes

Syndesmosis Fixation Review References

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