Comparative clinical efficacy of absorbable screws versus metal screws for internal fixation in treating acute tibiofibular syndesmosis injury

To analyze and compare the clinical efficacy of absorbable screws versus metal screws for internal fixation in treating acute tibiofibular syndesmosis injury. We conducted a retrospective analysis on the clinical data of 86 patients with acute distal tibiofibular syndesmosis injuries who underwent surgical treatment at our hospital from September 2022 to October 2023. According to the treatment methods, the patients were divided into an experimental group (absorbable screws, 43 cases) and a control group (metal screws, 43 cases). We observed and compared perioperative indicators, Berg Balance Scale (BBS) ankle joint scores, X-ray examination results, and incidence of adverse reactions between the two groups. We observed and compared perioperative indicators, BBS ankle joint scores, X-ray examination results, and the incidence of adverse reactions between the two groups. Before surgery, there was no significant difference in the tibiofibular gap and overlap width between the two groups (p > 0.05). After surgery, the study group had less intraoperative blood loss, lower postoperative pain scores, smaller tibiofibular gap, and lower incidence of adverse reactions. Moreover, the study group had earlier postoperative weight-bearing recovery and resumption of daily activities. Additionally, the study group showed significantly higher overlap width of the tibiofibular bones, joint stability, activity scores, walking, running, workability and imaging results scores (p < 0.05). Absorbable screws for internal fixation demonstrate superior clinical efficacy in treating acute tibiofibular syndesmosis injury.

Absorbable screws; Metal screws; Internal fixation; Acute tibiofibular syndesmosis injury

[1] Liu Z, Gao W, Zhang X, Wang W, Tan M, Qiu E, et al. The distance between the anterior and posterior edges of the fibula at a lateral internal rotation of 15° is associated with postoperative malreduction in patients with an ankle joint fracture combined with a lower tibiofibular syndesmosis injury. Advances in Clinical and Experimental Medicine. 2024; 33: 343–350.

[2] Medina McKeon JM, Hoch MC. The ankle-joint complex: a kinesiologic approach to lateral ankle sprains. Journal of Athletic Training. 2019; 54: 589–602.

[3] Zhao J, Zhang Y, Xia Y, Wang X, Xu S, Xie Y. Application of an arched, Ni-Ti shape-memory connector in repairing distal tibiofibular syndesmosis ligament injury. BMC Musculoskeletal Disorders. 2022; 23: 476.

[4] Bui GA, Huang JI. Intramedullary screw fixation of metacarpal and phalangeal fractures. Hand Clinics. 2023; 39: 475–488.

[5] McClure TT, Taylor BC, Huber G, Glazier M, Myers DM, DeGenova DT. Intramedullary screw fixation versus traditional plating for distal fibula fractures. The Journal of Foot and Ankle Surgery. 2023; 62: 355–359.

[6] Debieux P, Franciozi CE, Lenza M, Tamaoki MJ, Magnussen RA, Faloppa F, et al. Bioabsorbable versus metallic interference screws for graft fixation in anterior cruciate ligament reconstruction. Cochrane Database of Systematic Reviews. 2016; 7: CD009772.

[7] Labrador J, Carrera I, Holdsworth A. Extended computed tomography scale images provide a detailed assessment of metal screws and are superior to standard computed tomography scale images and digital radiography at detecting experimentally induced screw fractures in vitro. Veterinary and Comparative Orthopaedics and Traumatology. 2022; 35: 230–238.

[8] Zhu N, Zhong Q, Zhan J, Zhang S, Liu W, Yao Y, et al. A new type of elastic fixation, using an encircling and binding technique, for tibiofibular syndesmosis stabilization: comparison to traditional cortical screw fixation. Journal of Orthopaedic Surgery and Research. 2023; 18: 269.

[9] Olory BCR, Marín Fermín T, Papakostas E, Al-Khelaifi K, Zikria BA, D’Hooghe P. Simultaneous single-graft tibiofibular syndesmosis and deltoid ligament reconstruction in chronic instability: technical tip. Foot & Ankle International. 2023; 44: 790–795.

[10] Pechlivani C, Grammatikopoulou D, Antonoglou G, Pelopidas T, Varvarousis DN, Vrettakos A. Lateral ankle instability after rotational injury: a case report. Journal of Orthopaedic Case Reports. 2023; 13: 137–141.

[11] Yüce A, Misir A, Yerli M, Bayraktar TO, Tekin AÇ, Dedeoğlu SS, et al. Syndesmosis injuries in lateral malleolar fractures accompanied by a posterior malleolar fracture: a nonfixed posterior fracture fragment may not affect postoperative tibiofibular joint malreduction rates. Journal of the American Podiatric Medical Association. 2023; 113: 21–105.

[12] Zhu HB, Zhang YT, Lyu H, Ren FC, Zhou CH, Ying YF. Comparative study of minimally invasive titanium elastic nail and steel plate on the treatment of fracture of tibiofibular fracture in adults. Zhongguo Gu Shang. 2024; 37: 352–357. (In Chinese)

[13] Yüce A, Yerli M, Imren Y, Dedeoglu SS, Cabuk H, Gurbuz H. Distal tibiofibular malreduction in ankle fractures received fibula plate and syndesmotic screw fixation. Journal of the American Podiatric Medical Association. 2023; 113: 21–167.

[14] Chen B, Wang Z, Chen Z, Qu X, Fang X, Wang X, et al. Retracted: Comparison of two surgical approaches to supination-external rotationtype ankle fractures. Journal of Healthcare Engineering. 2023; 2023: 9840241.

[15] Zhang L, Xiong JX, Zhou X, Xiong LJ, Yu L. Biomechanical comparison of screw, tightrope and novel double endobutton in the treatment of tibiofibular syndesmotic injuries. Injury. 2021; 52: 2813–2819.

[16] Privalov M, Swartman B, Beisemann N, Barbari JE, Franke J, Grützner PA, et al. Influence of unstable ankle fracture (type Weber C), osteosynthesis and syndesmotic transfixation on position of fibula in tibiofibular notch: a cadaveric study. European Journal of Trauma and Emergency Surgery. 2022; 48: 1445–1452.

[17] Yuan X, Zhang B, Hu J, Lu B. Comparison of short-term effectiveness of metal screws and absorbable screws in repair of distal tibiofibular syndesmosis. Chinese Journal of Reparative and Reconstructive Surgery. 2022; 36: 989–994. (In Chinese)

[18] Zhang L, Wang R, Yang S, Jiang S, You G, Shi H, et al. Anterior talofibular ligament repair in combination with anterior tibiofibular ligament distal fascicle transfer for the treatment of chronic lateral ankle instability: a finite element analysis. The Journal of Foot and Ankle Surgery. 2024; 63: 435–442.

[19] Shao J, Kong DC, Zheng XH, Chen TN, Yang TY. Postoperative complications of concomitant fat embolism syndrome, pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: a case report. World Journal of Clinical Cases. 2021; 9: 476–481.

[20] Yaradılmış YU, Polat Y, Uslu MB, Ateş A, Demirkale İ, Altay M. The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: a regional study in Turkey. Joint Diseases and Related Surgery. 2020; 31: 123–129.

[21] Yuce A, Dedeoglu SS, Imren Y, Yerli M, Gurbuz H. Two-stage surgical procedure in intra-articular distal tibiofibular fractures with soft tissue injury: in which stage should the fibular plate be applied at initial surgery? Malaysian Orthopaedic Journal. 2020; 14: 90–97.

[22] Zhao Y, Zhu Z, Lu M, Chang J, Zheng S, Kent Kwoh C, et al. Irregular types of proximal tibiofibular joint increase the risk of total knee replacement: data from the osteoarthritis initiative. Journal of Orthopaedic Research. 2022; 40: 1787–1793.