The public defence will be held as a video conference over Zoom.
The defence will follow regular procedure as far as possible, hence it will be open to the public and the audience can ask ex auditorio questions when invited to do so.
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Due to copyright reasons, an electronic copy of the thesis must be ordered from the faculty. In order for the faculty to have time to process the order, it must be received by the faculty no later than 2 days prior to the public defence. Orders received later than 2 days before the defence will not be processed. Inquiries regarding the thesis after the public defence must be addressed to the candidate.
Digital Trial Lecture - time and place
Adjudication committee
- First opponent: Associate Professor Scott Ellis, The Hospital for Special Surgery, New York, USA
- Second opponent: Senior Consultant Hendrik Frølich Stange Fuglesang, Akershus University Hospital, Lørenskog
- Third member and chair of the evaluation committee: Professor II Inger Holm, Institute of Health and Society, University of Oslo
Chair of defence
Professor II Magne Røkkum, Institute of Clincal Medicine, University of Oslo
Principal supervisor
Head of Orthopaedic Department Wender Figved, Bærum Hospital, Gjettum
Summary
In 10-13% of surgically treated ankle fractures the syndesmotic ligaments are ruptured, resulting in ankle instability. Untreated, syndesmotic instability can cause chronic ankle pain and osteoarthritis (OA). Several implant options exist for syndesmotic stabilization, including screws and suture buttons (SB). The incidence of posterior malleolar fractures in ankle fractures (PMFs) varies in the literature. A PMF can amplify ankle instability and affects outcome. Fracture morphology assessed with CT can guide treatment.
The aims of the thesis were to compare clinical and radiological outcomes between different implants for syndesmotic fixation in supra syndesmotic ankle fractures. In addition, to state the incidence and further classify PMFs in patients with surgically treated supra syndesmotic ankle fractures.
To compare implant options, two randomized controlled trials (RCT) were conducted. To assess PMF presence, morphology classified by the Haraguchi classification and outcomes, patients from both RCTs were included in a diagnostic cohort study.
When comparing SB to a quadricortical 4.5 mm screw, superior syndesmotic reduction, patient reported outcome measures (PROMS) and lower rate of OA was found for the SB. When comparing SB to a 3.5 mm tricortical screw, no difference in syndesmotic reduction, PROMS, OA and ankle motion was found. In both RCTs; implants did not affect pain, complication rate or quality of life.
Plain radiographs missed 34% of all PMF compared to CT. Patients with a Haraguchi type II fracture (a fracture with an extension to the medial malleolus) had a poorer outcome up until 6 months. We found the Haraguchi classification system to have a substantial interrater agreement.
In conclusion, the RCTs recommends to stabilize a syndesmotic instability with a tricortical syndesmotic screw or a suture button. We recommend CTs for preoperative planning of complex ankle fractures. The Haraguchi classification is reliable for PMF assessment.
Additional information
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