A comparison of fixation methods in the management of adolescent ankle syndesmotic injuries with closed growth plate

Rationale: Ankle injuries involving the tibiofibular syndesmosis often require surgical treatment and selection of the optimal fixation method to restore joint stability. Recent studies in adults have shown that tibiofibular fixation using the TightRope syndesmosis system results in a better functional outcome than screw fixation [1; 2]. There is little evidence to support the preferred design in children and adolescents [3]. This study reviewed the surgical outcomes of two different tibiofibular fixation techniques for ankle syndesmosis injuries in adolescents.Objective: To compare two methods of fixation of the tibiofibular syndesmosis in adolescents to improve treatment outcomes.Methods: A prospective study of patients with a closed growth plate was performed. The age of the patients ranged from 15 to 17 years, the total number of children was 62 people. This cohort of patients was divided into two groups: the main and the control. In the main group, the tibiofibular syndesmosis was fixed using the TightRope system, in the control group, the tibiofibular fixation was performed using a 3.5 mm cortical screw. To assess the recovery of the ankle and foot function, the international FAAM scale (adl subscale) was used at 8-10 weeks and 6 months from the injury. Statistical analysis of the data was performed with the calculation of Student’s t-test at a significance level of p≤0.05.Results: In the main group, the number of excellent results increased by 9.8% compared to the control group at 10-12 weeks, and satisfactory results by 51.3% at p≤0.05 at 10-12 weeks based on statistical analysis of the results of ankle and foot function recovery according to the FAAM scale (adl subscale). The number of excellent and good results increased by 7.2% six months after the injury.Conclusions: The use of the TightRope system allowed for earlier loading of the limb, which led to a significant improvement in ankle and foot function at all stages of recovery.