Orthopaedic department, Scarborough Hospital, Woodland Drive, Scarborough, UK, YO12 6QL


Introduction: There are many controversial issues in the management of high fibular ankle fractures. The aim of current study to compare treatment options. Material and Methods: Ninety patients with high fibular ankle diastasis fractures were treated in the York and Scarborough NHS Trust between 2011-2014. The reviews included assessment of the radiographs on the patient archiving and communication system (PACS) and the patient's notes using Core patient data base (CPD). Mean follow up period was of 2.9 years. Results: Eighty two patients, who sustained Weber C ankle fractures, underwent open reduction and internal fixation of fibula, in 8 patients with high fibular fracture, only diastasis screw was used without plate fixation. Those who have had lateral malleolar fracture fixation required additional diastasis fixation in 51 patients (57%). The methods of diastasis fixation, was with using a screw passed through fibular plate (55%), or using a screw without plate fixation (15%) and using tight rope fixation. When a screw was used for diastasis fixation, the screw was passed through 3 cortices (80%); in the remaining the screw fixed four cortices. The average distance of the diastasis screws from the tibial plafond articular surface was 2.39cm. Eighteen diastasis screws were removed at an average time of 31weeks' post-surgery. Conclusion: Radiological improvement following surgery for Weber C ankle fracture was within the accepted variations, there was no difference between tight rope and screw syndesmotic fixation. Diastasis screws can be keeping without removing especially when tricortical fixation is used and the screws inserted just above syndesmosis. Only (50%) of unstable ankle fracture required diastasis fixation.