Preoperative Radiographic Instability does not Always Require Syndesmotic Screw Fixation in Isolated Lateral Malleolus Fractures

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Ince Y., Afacan M. Y., Akbaba D., Korkmaz T.

MEDICAL JOURNAL OF BAKIRKOY, vol.22, no.2, pp.177-183, 2026 (ESCI, Scopus, TRDizin)

  • Publication Type: Article / Article
  • Volume: 22 Issue: 2
  • Publication Date: 2026
  • Doi Number: 10.4274/bmj.galenos.2026.2026.3-7
  • Journal Name: MEDICAL JOURNAL OF BAKIRKOY
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, CINAHL, EMBASE, TR DİZİN (ULAKBİM), Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
  • Page Numbers: pp.177-183
  • Open Archive Collection: AVESIS Open Access Collection
  • Istanbul University Affiliated: No

Abstract

Objective: To compare pain, functional outcomes, and complication rates in patients with isolated lateral malleolus fractures who were considered to have syndesmotic instability on preoperative radiographic evaluation but were treated with or without syndesmotic screw fixation according to intraoperative assessment after fibular fixation. Methods: This retrospective cohort study included 43 adult patients who underwent surgical treatment for isolated lateral malleolus fractures and had preoperative radiographic findings suggestive of syndesmotic instability. After open reduction and internal fixation of the fibula, syndesmotic stability was reassessed intraoperatively under fluoroscopy using the Cotton test, with additional external rotation stress testing when needed. Patients were divided into a stable group who did not require syndesmotic fixation (n=23) and an unstable group who underwent syndesmotic screw fixation (n=20). Pain was assessed using the visual analogue scale (VAS) at 1 year postoperatively, and functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score at 2 years postoperatively. Results: The median age was 28 years [interquartile range (IQR), 22-45], and the median follow-up was 30 months (IQR, 26-44). Baseline demographic characteristics and follow-up duration were comparable between groups. Median VAS scores were 1 (IQR, 1-2) in the stable group and 1 (IQR, 1-2.75) in the unstable group (p=0.633). Median AOFAS scores were 91 (IQR, 88-93) and 90.5 (IQR, 82.25-93.50), respectively (p=0.750). Complication rates were 4.3% and 15.0%, respectively; the difference was not statistically significant (p=0.395). Conclusion: Selective syndesmotic fixation based on intraoperative assessment after fibular fixation may be a reasonable strategy for radiographically unstable, isolated lateral malleolus fractures.