Treatment of Maisonneuve fracturewitharthroscopic-assistant plate-screw fixation of the syndesmosis

Objective To investigate the effect of the treatment for Maisonneuve fracture with arthroscopic-assistant plate-screw fixation ofsyndesmosis. Methods From January 2015 to December 2016, totally 22 patients with Maisonneuve fracture were treated in Shanghai Jiao Tong University Affiliated Six People′s Hospital. Eleven patients in minimal invasive surgery (MIS)group were treated by the arthroscopic-assistant plate-screw fixation ofthe syndesmotic injury. Another 11 patients in the control group were performed a classic syndesmosis screw fixation. Plain radiographic examination was carried out during the follow-up. Functional evaluation was measured according to the American Orthopedic Foot Ankle Society (AOFAS) ankle hindfoot score and the Visual analogue scale(VAS). A t test was applied for the statistic analysis of post-operative outcome between the two groups at 6th and 12th month. Results The patients were followed for an average 18 months (range from 12 to 24 months) except one of MIS group.The X-ray demonstrated the solid bone union occurred on the 12th week in MIS group and 12.5th week in the control group. The implants of syndesmosis were removed at 12th week post-operatively. No cases of re-diastasis occurred during the follow-up. There was significant difference with in the groups. In the MIS group, the AOFAS ankle hindfoot score was (85.9±4.1) points at 6th month post-operatively, and increased to (90.8±3.7) at 12th month (P<0.05). VAS score was (2.4±1.2) at 6th month and (1.1±0.7) at 12th month after the operation(P<0.05). In the control group, the AOFAS ankle hindfoot score was (81.1±4.7) points at 6th month after operation, and increased to (89.1±3.4) at 12th month after operation (P<0.05). VAS score was (3.2±1.3) at the 6th month and (1.0±1.0) at the 12th month after operation(P<0.05). However, for the outcome comparison between the two groups, only the AOFAS ankle hindfoot score of 6th month post-operatively in MIS group was better than the control group (P<0.05), other results, had no significant difference.Nocomplications of implant failure, nonunion, malunion or post-traumatic arthritis were occurred during the follow-up. Conclusion The treatment of Maisonneuve fracture by arthroscopic-assistant plate-screw fixation proved to have an advantage of minimal invasion and accurate reduction and fixation, which is a safe and effective surgical method. Key words: Ankle joint; Fracture; Fracture fixation, internal; Arthroscopes