THE MANAGEMENT OF ANKLE SYNDESMOSIS INJURIES – A NATIONAL AUDIT OF UNITED KINGDOM PRACTICE AND COMPARISON WITH PUBLISHED RECOMMENDATIONS.

The importance of correctly identifying and treating ankle syndesmosis injuries is paramount to achieving a good functional result. Although it is clear that anatomical correction is essential the practical aspects remain disputed. Controversial issues include diagnosing and determining which injuries need treating, the number and size of screws for fixation, the number of cortices engaged, a screw removal strategy and the use of biodegradable screws or other forms of fixation. We report the results of a survey of 440 orthopaedic surgeons to determine current UK practice, this is then compared to best practice as determined by literature review. When analysis was performed for the group and by sub-speciality (foot and ankle, trauma and general orthopaedics) we found large differences in practice. Furthermore it appeared that some aspects of treatment varied considerably from published evidence, for instance four out of five screws were removed much earlier than clinical studies have recommended.