Background: Bioabsorbable implants have restricted
indications because of their unique biochemical properties and their
inferior biomechanical properties compared with those of conventional metallic
implants. The purpose of this prospective study was to assess the
efficacy of screws made of polylevolactic acid (PLLA) in the treatment
of syndesmotic disruptions associated with ankle fractures and fracture-dislocations.
Methods: Thirty-three consecutive patients with
a syndesmotic disruption were managed with standard metallic plate-and-screw fixation
of the malleolar fracture and with 4.5-mm polylevolactic acid screws,
with purchase in four cortices, for fixation of the syndesmosis.
Intraoperative radiographs confirmed reduction of the syndesmosis,
and all of the patients were managed with a non-weight-bearing plaster
splint or brace for six weeks. Clinical and radiographic assessment
and functional evaluation with use of the Olerud-Molander scoring system
were performed at the time of follow-up.
Results: Ten patients were lost to follow-up prior
to the twenty-four-month evaluation, leaving twenty-three patients
with an average duration of follow-up of thirty-four months (range, twenty-four
to forty-three months). All of the malleolar fractures healed in
an anatomical position at an average of three months, and no postoperative
displacement of the syndesmosis or widening of the medial clear
space was detectable on radiographs. No episodes of osteolysis or
late inflammation secondary to the hydrolyzed polylactide occurred.
Nineteen patients (83%) had an excellent result, and four
patients (17%) had a good result. All twenty-three patients
returned to their preinjury level of work and activities of daily
living. No patient had malunion, nonunion, loss of reduction, or
complications attributable to the biomechanical or biochemical properties
of the implants.
Conclusions: Polylevolactic acid screws are effective
in stabilizing disruption of the syndesmosis during healing of unstable
ankle fractures. In this small series, the bioabsorbable screw was
well tolerated, and there was no need for a second operation to remove