Abstracts / Injury Extra 41 (2010) 167–196 185 1B.52 Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures associated with syndesmotic injury R. Mohammed, S. Syed, S.A. Ali Selly Oak Hospital, University Hospital Birmingham NHS Trust, United Kingdom Objective: To determine the functional and radiographic out- come of supra-syndesmotic fibular fractures associated with syndesmotic disruption treated with syndesmosis-only fixation. Methods: A retrospective observational study was performed in 12 patients who had fracture patterns amenable to syndesmosis- only fixation. According to the Lauge-Hansen classification, 10 were pronation external rotation injuries and 2 were pronation abduc- tion injuries. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomi- cally reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient each had a single tricortical cortical screw fixation across the syndesmosis. Patients were kept non-weight bearing for 6 weeks followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective (Olerud and Molander Scale) ankle scoring sys- tem and by radiographic assessment of the ankle mortise. Results: Ankle mortise was reduced in all cases and all but one fibular fracture united without loss of fixation. At a mean follow up of 13 months, functional outcome score was 75. Six patients had more than one malleolar injury needing either screw or anchor fix- ations. One patient with trimalleolar fracture had residual ankle stiffness which responded to intensive physiotherapy. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of fibula. Discussion: With the length of the fibula restored and the syn- desmosis reduced anatomically, internal fixation using a plating device may not necessary for fibular fractures combined with dias- tasis of inferior tibio-fibular joint. In our series, good or excellent results were obtained in majority of the patients. The patient with late diastasis after syndesmotic screw removal was proba- bly due to early screw removal before union of the fibular fracture. Essential to this method of treatment are restoration of the fibu- lar length, anatomical reduction of the syndesmosis and delaying screw removal till the fibular fracture heals. Conclusions: Syndesmotic-only fixation for supra-syndesmotic fibular fractures associated with syndesmotic disruption is a safe and effective method. doi:10.1016/j.injury.2010.07.375 1B.53 Pragmatic treatment of ankle fractures of uncertain stability: clinical features and risk of displacement S. Akhtar, A. Fox, J. Barrie East Lancs Foot + Ankle Service, East Lancs Hospitals Trust, UK Biomechanical and clinical studies have demonstrated that the most important determinant of treatment of malleolar fractures is stability. Stable fractures have an intact deep deltoid ligament, do not displace with functional treatment and weightbearing, and do not require radiological follow-up. If the deep deltoid/medial malleolar complex is disrupted, a malleolar fracture may display instability, including displacement of the talus in the ankle mortise. However, several studies have suggested that some malleolar frac- tures that are undisplaced on presentation are unstable and may displace during treatment. Recent studies have focused on the role of stress radiography or MR scanning to assess stability. Prior to the publication of these studies, we developed clinical criteria for potential instability and applied them in a pragmatic way to a prospective series of patients. These included: a medial clear space of <4 mm; medial tender- ness, bruising or swelling; a fibular fracture above the syndesmosis; a bimalleolar or trimalleolar fracture; an open fracture; a high- energy fracture mechanism. Patients with a medial clear space of <4 mm and none of these criteria were considered to have stable fractures, while those with a medial clear space of >4 mm were considered to have a displaced fracture. This is a prospective study of 152 consecutive skeletally mature patients with undisplaced, potentially unstable malleolar fractures treated by the senior author between 1st January 1998 and 31st December 2007. During the same period we treated 237 stable fractures and 110 displaced fractures. Patients were treated in a below-knee walking cast (136 patients) or a functional ankle brace (16 patients) for 6 weeks. Weightbearing was encouraged through- out. Weightbearing radiographs were obtained at 1 week and 6 weeks. Displacement was defined as talar displacement with a medial clear space >4 mm. Demographic, clinical and radiological data were collected prospectively. There were 88 male and 64 female patients, with a median age of 43 years (range 14–93 years). Criteria for suspicion of instabil- ity were: lateral malleolar fracture with medial tenderness, 115 patients; proximal fibular fracture, 29 patients; bimalleolar frac- ture, 17 patients; other criteria, 15 patients (some had more than one criterion). Three fractures displaced (risk of displacement 2.0%, 95% CI 0.4–5.7%). All displaced within the first week and were treated by open reduction and internal fixation. One bimalleo- lar fracture developed a symptomatic medial malleolar non-union which was treated by percutaneous screw fixation (risk of non- union 5.9%, 95% CI 0.1–28.7%). All the other fractures achieved clinical union by 8 weeks. It is possible that some of these fractures were stable enough to treat more functionally. However, patients were satisfied with the treatment programme which avoided painful and time-consuming stress radiography. In other series some of these patients would probably have had surgical fixation but this programme avoided the risks of wound infection and nerve injury which may be 10% or higher. The best method of assessing and treating these patients is not yet known—this method has the advantages of simplicity with minimal risk. doi:10.1016/j.injury.2010.07.376 1B.54 Evaluation of variable locking plate (VLP) fixation of lateral malleolus fractures of the ankle N. Peterson, G. Kumar, J. Widnall, B. Narayan Royal Liverpool University Hospital, Trauma & Orthopaedics, Liver- pool, United Kingdom Background: Plate stabilisation of ankle fractures is a common orthopaedic operation. Peri-Loc Variable Angle Locking Plates (VLP) (Smith & Nephew) have been used for comminuted and osteo- porotic fractures in our institution since May 2008. This study was performed to assess VLP stabilisation of lateral malleolus fractures. Methods and materials: From August 2008 to January 2010, 20 consecutive patients (mean age 51 years) with unstable ankle frac- tures were treated with VLP. Average delay to surgery was 9 days. Case notes and radiographs were reviewed at a mean follow up of 17 weeks (8–54 weeks). Clinical outcome was assessed using SF36 and short musculoskeletal function assessment (sMFA) question- brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Elsevier - Publisher Connector