Halis Atıl Atilla1, Alper Öztürk1, Yenel Gürkan Bilgetekin1, Hakan Aslan1, Mehmet Orçun Akkurt2, Mutlu Akdoğan1

1Department of Orthopedics and Traumatology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
2Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey

Keywords: Ankle fracture, surgeon preference, survey, syndesmotic injury.


Objectives: This study aims to investigate the attitudes of orthopedic surgeons to the management of ankle fractures accompanied by syndesmotic injury with a nationwide survey.

Patients and methods: In the first step of this descriptive study, an electronic survey was prepared in Google drive and a survey link was sent to the Turk-Ortopedi e-mail group between 09 and 19 January 2019. The orthopedic surgeons and residents were requested to complete the questionnaire. A total of 320 orthopedic surgeons (77%) and residents (23%) participated in the survey. The responses were analyzed statistically. To evaluate the changing attitudes, our results were compared with the surgeon survey studies key worded “syndesmotic injury” in PubMed.

Results: The majority of the participants stated that they used the hook test, external rotation stress test, and fluoroscopy together (47.2%) for the diagnosis of syndesmotic injury during the operation. Of the participants, the majority (93%) reported to use metallic syndesmotic screws, and 59% reported to remove the syndesmotic screw routinely. Young surgeons with five to 10 years of experience preferred intraoperative diagnosis methods compared to surgeons with more than 20 years of experience. Foot and ankle surgeons and sports surgeons reported to allow weight bearing before removal of the screw much more than other unspecified branches.

Conclusion: The preferences of the surgeon vary in syndesmotic injuries and there is still no consensus regarding diagnosis and rehabilitation. Compared to the past decade, fewer surgeons prefer to remove the screws today.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.


We thank Bülent Çelik, MD, Mehmet Faruk Çatma, MD, Atakan Gülsoy, MD, Muhammet Hayat, MD, and Barış Ekin Demir, MD, for their precious efforts and comments in the preparation of the questionnaire.