The aim of this study was to evaluate the long-term outcomes of patients who had sustained an unstable ankle fracture with a
Background. Tightrope fixation has been suggested as an alternative to screw stabilisation for distal tibiofibular joint diastasis that provides stability but avoids the problems of rigid screws across the joint. Recent case series (of 6 and 16 patients) have however, reported soft tissue problems and infections in 19–33% of patients. This study aims to review treatment and complications of distal tibiofibular diastasis fixation in our unit with the use of Tightrope or diastasis screws. Methods. Retrospective review of all patients undergoing primary ankle fixation between May 2008 and October 2009. Exclusions included revision procedures, or ankle fixation prior to the current fracture. Those undergoing Tightrope or diastasis screw fixation were studied for any complications or further procedures. Clinical records and XRAYs were reviewed, family practitioners of the patients were contacted and any consultations for ankle related problems noted. Results. 187 primary ankle fixation procedures were performed. 35 ankles required stabilisation of the distal tibiofibular joint. In 12, this was achieved using the Tightrope and in 23, syndesmotic screws were used. There was no difference in the adequacy of reduction in the two groups. Of those stabilised with a Tightrope, 6 were Maisonneuve injuries, 5 Weber C and 1 Weber B. 1 was lost to followup. Of the remaining 11, none had complications attributable to the method of fixation documented in hospital or family practitioner records. One had a small stitch abscess that settled on removal of the suture material. None underwent subsequent procedures. Of 23 stabilised with screws, 4 were Weber B, 14 Weber C, 4 Maisonneuve and 1 syndesmotic injury associated with an isolated