Operative treatment of tibiofibular diastasis: a comparative study between transfixation screw and reabsorbable cerclage. Preliminary result

Objectives. The tibiofibular diastasis requires an appropriate surgical treatment in order not to run into negative results such as decreased range of motion and chronic instability. We have conducted a comparative study between the transfixation screw and a new technique based upon the reabsorbable cerclage, a less invasive technique. Materials and Methods. We enrolled 30 patients affected by tibiotarsal distortion with an acute lesion of the syndesmosis, and we divided them in 2 groups randomly. The first group of patients (15 cases) has been treated with a tricortical, or quadricortical syndesmotic screw, and the second group of patients (15 cases) has been treated with a tibiofibular cerclage with reabsorbing wires. The evaluation of the lesions was documented through comparative radiographies of the ankle in the AP, LL and mortise projections. Results. In group 1, we observed an excellent outcome in 4 patients, while in the remaining 11 cases there was evidence of alterations in the evaluated parameters. In group 2, we observed an excellent outcome in 6 patients, and only in half of the remaining cases it was found a slight alteration only when the articulation is stressed. Conclusions. The main indications for the tibiofibular cerclage are the syndesmotic lesions not associated to fibular fractures. The achieved results support the validity of the cerclage technique, showing evidence of advantages concerning the functional recovery. The cerclage also allows to avoid the subsequent surgery required for the screw removal. Therefore the tibiofibular cerclage represents a valid alternative to the treatment with the syndesmotic screw. Clin Ter 2011; 162(6):e161-167