Does syndesmotic injury have a negative effect on functional outcome? A multicenter prospective evaluation

Jody Litrenta, David Saper, Paul Tornetta, Laura Phieffer, Clifford B. Jones, Brian Mullis, Kenneth Egol, Cory Collinge, Ross K. Leighton, William Ertl, William M. Ricci, David Teague, Janos Ertl

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: To evaluate the effect of syndesmotic disruption on the functional outcomes of Weber B, SE4 ankle fractures treated operatively. Setting: Multicenter trauma hospitals. Patients: Data were prospectively gathered during a previous, multicenter randomized trial including 242 patients (136 women, 106 men) from 9 trauma centers with operatively treated Weber B SE4 ankle fractures. There were 81 patients (35%) with syndesmotic instability confirmed intraoperatively after fibula fixation. Intervention: Functional evaluations were performed postoperatively at 6, 12, 26, and 52 weeks. The presence of symptomatic hardware and peroneal tendon discomfort was evaluated with 9-12 months of follow-up. Main Outcome Measures: Functional outcomes evaluated included Short Musculoskeletal Function Assessment (SMFA), Bother index, and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The recovery curve of the 2 groups was analyzed using a mixed linear regression analysis for repeated measures and included gender and race in the model. Symptomatic hardware and peroneal tendon discomfort were compared between the 2 groups with a χ 2 analysis. Results: The adjusted mean linear regression analyses demonstrated that patients without a syndesmotic injury had better functional outcomes for some outcome measures. SMFA scores at 12 weeks were statistically lower in patients without syndesmotic injury (P 0.02), but not at other visits. AOFAS scores were significantly higher (P 0.0006), and Bother index trended toward lower results (P 0.07) in patients without syndesmotic injury at all time points. Isolated analyses (T-tests) at 1 year demonstrated a difference in the SMFA (P 0.04) and Bother index (P 0.05), but not the AOFAS (P 0.21). Men consistently demonstrated better recovery than women for all outcomes, whereas race was not significant for any measure. Symptomatic hardware and peroneal tendon irritation was not statistically different between the groups. Conclusions: The recovery curves after ankle fractures were different based on syndesmotic injury. However, the difference was at the limit of clinical significance. Syndesmotic injury has a slightly detrimental effect on outcomes of operatively treated Weber B SE4 fractures. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)410-413
Number of pages4
JournalJournal of Orthopaedic Trauma
Volume29
Issue number9
DOIs
StatePublished - Sep 22 2015

Fingerprint

Ankle Injuries
Ankle Fractures
Ankle
Tendons
Orthopedics
Foot
Linear Models
Regression Analysis
Outcome Assessment (Health Care)
Fibula
Trauma Centers
Multicenter Studies
Wounds and Injuries

Keywords

  • functional outcomes
  • syndesmotic injury
  • trauma
  • Weber B ankle fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Does syndesmotic injury have a negative effect on functional outcome? A multicenter prospective evaluation. / Litrenta, Jody; Saper, David; Tornetta, Paul; Phieffer, Laura; Jones, Clifford B.; Mullis, Brian; Egol, Kenneth; Collinge, Cory; Leighton, Ross K.; Ertl, William; Ricci, William M.; Teague, David; Ertl, Janos.

In: Journal of Orthopaedic Trauma, Vol. 29, No. 9, 22.09.2015, p. 410-413.

Research output: Contribution to journalArticle

Litrenta, J, Saper, D, Tornetta, P, Phieffer, L, Jones, CB, Mullis, B, Egol, K, Collinge, C, Leighton, RK, Ertl, W, Ricci, WM, Teague, D & Ertl, J 2015, 'Does syndesmotic injury have a negative effect on functional outcome? A multicenter prospective evaluation', Journal of Orthopaedic Trauma, vol. 29, no. 9, pp. 410-413. https://doi.org/10.1097/BOT.0000000000000295
Litrenta, Jody ; Saper, David ; Tornetta, Paul ; Phieffer, Laura ; Jones, Clifford B. ; Mullis, Brian ; Egol, Kenneth ; Collinge, Cory ; Leighton, Ross K. ; Ertl, William ; Ricci, William M. ; Teague, David ; Ertl, Janos. / Does syndesmotic injury have a negative effect on functional outcome? A multicenter prospective evaluation. In: Journal of Orthopaedic Trauma. 2015 ; Vol. 29, No. 9. pp. 410-413.
@article{d7d79b74a7e74caf91016acdd3c34cb5,
title = "Does syndesmotic injury have a negative effect on functional outcome? A multicenter prospective evaluation",
abstract = "Objective: To evaluate the effect of syndesmotic disruption on the functional outcomes of Weber B, SE4 ankle fractures treated operatively. Setting: Multicenter trauma hospitals. Patients: Data were prospectively gathered during a previous, multicenter randomized trial including 242 patients (136 women, 106 men) from 9 trauma centers with operatively treated Weber B SE4 ankle fractures. There were 81 patients (35{\%}) with syndesmotic instability confirmed intraoperatively after fibula fixation. Intervention: Functional evaluations were performed postoperatively at 6, 12, 26, and 52 weeks. The presence of symptomatic hardware and peroneal tendon discomfort was evaluated with 9-12 months of follow-up. Main Outcome Measures: Functional outcomes evaluated included Short Musculoskeletal Function Assessment (SMFA), Bother index, and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The recovery curve of the 2 groups was analyzed using a mixed linear regression analysis for repeated measures and included gender and race in the model. Symptomatic hardware and peroneal tendon discomfort were compared between the 2 groups with a χ 2 analysis. Results: The adjusted mean linear regression analyses demonstrated that patients without a syndesmotic injury had better functional outcomes for some outcome measures. SMFA scores at 12 weeks were statistically lower in patients without syndesmotic injury (P 0.02), but not at other visits. AOFAS scores were significantly higher (P 0.0006), and Bother index trended toward lower results (P 0.07) in patients without syndesmotic injury at all time points. Isolated analyses (T-tests) at 1 year demonstrated a difference in the SMFA (P 0.04) and Bother index (P 0.05), but not the AOFAS (P 0.21). Men consistently demonstrated better recovery than women for all outcomes, whereas race was not significant for any measure. Symptomatic hardware and peroneal tendon irritation was not statistically different between the groups. Conclusions: The recovery curves after ankle fractures were different based on syndesmotic injury. However, the difference was at the limit of clinical significance. Syndesmotic injury has a slightly detrimental effect on outcomes of operatively treated Weber B SE4 fractures. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.",
keywords = "functional outcomes, syndesmotic injury, trauma, Weber B ankle fracture",
author = "Jody Litrenta and David Saper and Paul Tornetta and Laura Phieffer and Jones, {Clifford B.} and Brian Mullis and Kenneth Egol and Cory Collinge and Leighton, {Ross K.} and William Ertl and Ricci, {William M.} and David Teague and Janos Ertl",
year = "2015",
month = "9",
day = "22",
doi = "10.1097/BOT.0000000000000295",
language = "English (US)",
volume = "29",
pages = "410--413",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Does syndesmotic injury have a negative effect on functional outcome? A multicenter prospective evaluation

AU - Litrenta, Jody

AU - Saper, David

AU - Tornetta, Paul

AU - Phieffer, Laura

AU - Jones, Clifford B.

AU - Mullis, Brian

AU - Egol, Kenneth

AU - Collinge, Cory

AU - Leighton, Ross K.

AU - Ertl, William

AU - Ricci, William M.

AU - Teague, David

AU - Ertl, Janos

PY - 2015/9/22

Y1 - 2015/9/22

N2 - Objective: To evaluate the effect of syndesmotic disruption on the functional outcomes of Weber B, SE4 ankle fractures treated operatively. Setting: Multicenter trauma hospitals. Patients: Data were prospectively gathered during a previous, multicenter randomized trial including 242 patients (136 women, 106 men) from 9 trauma centers with operatively treated Weber B SE4 ankle fractures. There were 81 patients (35%) with syndesmotic instability confirmed intraoperatively after fibula fixation. Intervention: Functional evaluations were performed postoperatively at 6, 12, 26, and 52 weeks. The presence of symptomatic hardware and peroneal tendon discomfort was evaluated with 9-12 months of follow-up. Main Outcome Measures: Functional outcomes evaluated included Short Musculoskeletal Function Assessment (SMFA), Bother index, and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The recovery curve of the 2 groups was analyzed using a mixed linear regression analysis for repeated measures and included gender and race in the model. Symptomatic hardware and peroneal tendon discomfort were compared between the 2 groups with a χ 2 analysis. Results: The adjusted mean linear regression analyses demonstrated that patients without a syndesmotic injury had better functional outcomes for some outcome measures. SMFA scores at 12 weeks were statistically lower in patients without syndesmotic injury (P 0.02), but not at other visits. AOFAS scores were significantly higher (P 0.0006), and Bother index trended toward lower results (P 0.07) in patients without syndesmotic injury at all time points. Isolated analyses (T-tests) at 1 year demonstrated a difference in the SMFA (P 0.04) and Bother index (P 0.05), but not the AOFAS (P 0.21). Men consistently demonstrated better recovery than women for all outcomes, whereas race was not significant for any measure. Symptomatic hardware and peroneal tendon irritation was not statistically different between the groups. Conclusions: The recovery curves after ankle fractures were different based on syndesmotic injury. However, the difference was at the limit of clinical significance. Syndesmotic injury has a slightly detrimental effect on outcomes of operatively treated Weber B SE4 fractures. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

AB - Objective: To evaluate the effect of syndesmotic disruption on the functional outcomes of Weber B, SE4 ankle fractures treated operatively. Setting: Multicenter trauma hospitals. Patients: Data were prospectively gathered during a previous, multicenter randomized trial including 242 patients (136 women, 106 men) from 9 trauma centers with operatively treated Weber B SE4 ankle fractures. There were 81 patients (35%) with syndesmotic instability confirmed intraoperatively after fibula fixation. Intervention: Functional evaluations were performed postoperatively at 6, 12, 26, and 52 weeks. The presence of symptomatic hardware and peroneal tendon discomfort was evaluated with 9-12 months of follow-up. Main Outcome Measures: Functional outcomes evaluated included Short Musculoskeletal Function Assessment (SMFA), Bother index, and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The recovery curve of the 2 groups was analyzed using a mixed linear regression analysis for repeated measures and included gender and race in the model. Symptomatic hardware and peroneal tendon discomfort were compared between the 2 groups with a χ 2 analysis. Results: The adjusted mean linear regression analyses demonstrated that patients without a syndesmotic injury had better functional outcomes for some outcome measures. SMFA scores at 12 weeks were statistically lower in patients without syndesmotic injury (P 0.02), but not at other visits. AOFAS scores were significantly higher (P 0.0006), and Bother index trended toward lower results (P 0.07) in patients without syndesmotic injury at all time points. Isolated analyses (T-tests) at 1 year demonstrated a difference in the SMFA (P 0.04) and Bother index (P 0.05), but not the AOFAS (P 0.21). Men consistently demonstrated better recovery than women for all outcomes, whereas race was not significant for any measure. Symptomatic hardware and peroneal tendon irritation was not statistically different between the groups. Conclusions: The recovery curves after ankle fractures were different based on syndesmotic injury. However, the difference was at the limit of clinical significance. Syndesmotic injury has a slightly detrimental effect on outcomes of operatively treated Weber B SE4 fractures. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

KW - functional outcomes

KW - syndesmotic injury

KW - trauma

KW - Weber B ankle fracture

UR - http://www.scopus.com/inward/record.url?scp=84940439762&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940439762&partnerID=8YFLogxK

U2 - 10.1097/BOT.0000000000000295

DO - 10.1097/BOT.0000000000000295

M3 - Article

C2 - 25635361

AN - SCOPUS:84940439762

VL - 29

SP - 410

EP - 413

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

IS - 9

ER -