Consistency of plain X-rays in ankle fractures with syndesmosis injury, a prospective cohort study

Purpose : This study aims at judging plain radiographs as an assessment tool for syndesmosis reduction in ankle fractures with syndesmosis affection. Methods: Prospectively, 46 patients with ankle fracture associated with syndesmosis injury were operated upon from March 2021 to July 2021. Immediate post-operative CT images were compared to X-rays to classify patients according to reduction. Functional outcome using AOFAS score was compared between different groups. Results: Out of 46 patients classified as class "A" or Acceptable reduction by X-rays, only 24 cases (52.3%) were classified as class "A" by CT studies with mean AOFAS (92), 16 cases (34.2%) were classified as class "B" with mean AOFAS (86) , and six cases (13.5%) were classified as class "C" with mean AOFAS (72), (p<0.001). Conclusion s: Plain X-rays are unreliable for assessing ankle fractures with a syndesmosis injury. It was evidenced by missed mal-rotations and tibio-fibular diastasis following reduction which reflected on the functional outcome of the patients. That is why CT studies are highly recommended in the early post-operative period (within one week).