OBJECTIVES : Syndesmosis fixation tactics and overall risk factors for complications are poorly defined. This study was designed to assess outcomes and payments from commercial insurance in patients diagnosed with ankle fractures and syndesmosis fixation.

METHODS : This study used data from the IBM MarketScan® Commercial database. Patients (18-64 years old) with an in- or outpatient diagnosis of ankle fracture treated surgically between 10/1/2015 – 7/31/2020 were identified. Eligible patients had continuous enrollment for one-year prior and post ankle fracture diagnosis (defined as the “index”). Variables included patient demographics, comorbidities and surgical intervention type (concurrent surgical procedures) at time of index. All patients were followed one-year post surgery. Outcomes included complication rates (infection, non-union, implant removal, pain after 30 days post-surgery, new diagnosis of arthritis, and instability) and 1-year payments. Standard descriptive statistics (proportion, mean, median) were calculated on all variables and outcomes. Generalized linear models (link: log, family type: gamma) and logistic regression models were built to define costs and risk factors for complications.

RESULTS : 7,981 were treated with syndesmosis fixation (mean age: 40 (SD:15), 51% female). Site of care was mostly outpatient (59% surgeries), 22% and 18% were inpatient and ambulatory surgical site cases, 1% other. One-year post-operative rates of complications were as follows: 1.4% infection, 1.6% non-union, 3.6% implant removal, 4.8% instability, 36.1% pain, 3.7% arthritis. Outpatient and inpatient payments averaged $8,440(SD: $17,823.73) and $39,148(SD: $66,280.44), respectively. Infection increased costs significantly ($78,253, 95% CI: $41,523-$147,448 P=0.0004). Arthritis was a key risk factor for residual pain (OR:2.05, CI:1.61-2.64, p<.0001).

CONCLUSIONS : 51% patients experienced complications or residual pain after syndesmosis repair. Further research is warranted to identify medical technologies to improve outcomes and reduce cost.