Acute and Chronic Syndesmotic Injury

Swords, Michael; Brilhault, J.; Sands, Andrew K.

doi:10.1016/j.fcl.2018.07.007

Cited by 11 publications

(6 citation statements)

References 32 publications

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“…This study evaluated syndesmosis reduction by analyzing postoperative axial CT images captured 1 cm proximal to the tibial plafond ( Table 1 and Figure 1 ) [ 16 , 17 , 18 , 19 ]. Four radiographic measurements were chosen and assessed with a PACS image viewer software (Dejaview2 version 1.0, Dongwun Information Technology, Republic of Korea).…”

Section: Methodsmentioning

confidence: 99%

The Outcomes of Mini-Plate Fixation for Unstable Wagstaffe Tubercle Fracture, an Indirect Syndesmosis Injury in Rotational Ankle Fracture

Lee,

Jung,

Yeo

et al. 2024

JCM

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Background: Wagstaffe fracture constitutes an indirect injury to the AITFL and can precipitate syndesmotic instability. The prevailing fixation methods often involve the use of mini-screws or K-wires, with absorbable suture repair reserved for cases with small or comminuted fragments exhibiting instability. In this study, we devised a mini-plate fixation method capable of securing the fracture fragment irrespective of its size or condition. Methods: A retrospective chart review was conducted on patients who underwent surgery for ankle fractures between May 2022 and October 2023. The surgical technique involved direct fixation of the Wagstaffe fracture using mini-plate fixation. Radiologic evaluation was performed using postoperative CT images, and clinical outcomes were assessed using the OMAS and VAS. Results: Fourteen patients with an average age of 62.5 years were included. Most fractures were associated with the supination-external rotation type. The average preoperative OMAS significantly improved from 5.95 to 83.57 postoperatively. The average VAS score decreased from 7.95 preoperatively to 0.19 postoperatively. Conclusions: The mini-plate technique for Wagstaffe fractures exhibited dependable fixation strength, effective fracture reduction, a minimal complication rate, and judicious surgical procedure duration.

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Section: Methodsmentioning

confidence: 99%

The Outcomes of Mini-Plate Fixation for Unstable Wagstaffe Tubercle Fracture, an Indirect Syndesmosis Injury in Rotational Ankle Fracture

Lee,

Jung,

Yeo

et al. 2024

JCM

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“…205 It has been realized that osseous equivalents of syndesmotic injury occur and should be treated with stable internal fixation anatomically, and these osseous equivalent injuries include fractures of the posterior malleolus, fracture of the Chaput tubercle of the tibia, fracture of the Wagstaffe tubercle of the distal fibula. 208 Recently "Quadrimalleolar Concept" for ankle fractures has been introduced according to which the ankle is divided into four areas on the axial CT scan: (A) (posterior malleolus), (B) (medial malleolus), (C) (lateral malleolus), and (D) (anterior malleolus Chaput and/or Wagstaffe fragments), and depending on the malleolus involved surgical approach and fixation strategy is suggested. 209 Posterior malleolar injury represents instability of the bony attachment of the PITFL, 208 and out of all ligaments stabilizing the syndesmosis PITFL provides the greatest strength.…”

Section: Syndesmotic Injuries With Ankle Fracturesmentioning

confidence: 99%

“…208 Recently "Quadrimalleolar Concept" for ankle fractures has been introduced according to which the ankle is divided into four areas on the axial CT scan: (A) (posterior malleolus), (B) (medial malleolus), (C) (lateral malleolus), and (D) (anterior malleolus Chaput and/or Wagstaffe fragments), and depending on the malleolus involved surgical approach and fixation strategy is suggested. 209 Posterior malleolar injury represents instability of the bony attachment of the PITFL, 208 and out of all ligaments stabilizing the syndesmosis PITFL provides the greatest strength. 18 A study concluded that fixation of PM restored PITFL function because all ankle fractures with posterior malleolus injury had intact PITFL which was attached to the fractured fragment.…”

Section: Syndesmotic Injuries With Ankle Fracturesmentioning

confidence: 99%

“…Posterior malleolar injury represents instability of the bony attachment of the PITFL, 208 and out of all ligaments stabilizing the syndesmosis PITFL provides the greatest strength. 18 A study concluded that fixation of PM restored PITFL function because all ankle fractures with posterior malleolus injury had intact PITFL which was attached to the fractured fragment.…”

Section: Syndesmotic Injuries With Ankle Fracturesmentioning

confidence: 99%

“…Wagstaffe tubercle represents the avulsion of the fibular attachment of the AITFL and must be recognized and addressed at the time of fixation. 208,209,218 By reducing and stabilizing the Chaput fragment, the AITFL ligament is tensioned, thus allowing the correct reduction of the fibula within the tibial incisura. 223 Its correct stabilization restores the anatomical configuration of the incisura fibularis and anterolateral tibial plafond and helps to avoid anterior and valgus displacement of the talus.…”

Section: Syndesmotic Injuries With Ankle Fracturesmentioning

confidence: 99%

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Instability of the distal tibiofibular syndesmosis

Vohra¹,

Singh²,

Thorat³

et al. 2023

J Orthop Surg (Hong Kong)

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The distal tibiofibular syndesmosis (DTFS) is more frequently injured than previously thought. Early diagnosis and appropriate treatment is essential to avoid long term complications like chronic instability, early osteoarthritis and residual pain. Management of these injuries require a complete understanding of the anatomy of DTFS, and the role played by the ligaments stabilizing the DTFS and ankle. High index of suspicion, appreciating the areas of focal tenderness and utilizing the provocative maneuvers help in early diagnosis. In pure ligamentous injuries radiographs with stress of weight bearing help to detect subtle instability. If these images are inconclusive, then further imaging with MRI, CT scan, stress examination under anesthesia, and arthroscopic examination facilitate diagnosis. An injury to syndesmosis frequently accompanies rotational fractures and all ankle fractures need to be stressed intra-operatively under fluoroscopy after fixation of the osseous components to detect syndesmotic instability. Non-operative treatment is appropriate for stable injuries. Unstable injuries should be treated operatively. Anatomic reduction of the syndesmosis is critical, and currently both trans-syndesmotic screws and suture button fixation are commonly used for syndesmotic stabilization. Chronic syndesmotic instability (CSI) requires debridement of syndesmosis, restoration of ankle mortise with or without syndesmotic stabilization. Arthrodesis of ankle is used a last resort in the presence of significant ankle arthritis. This article reviews anatomy and biomechanics of the syndesmosis, the mechanism of pure ligamentous injury and injury associated with ankle fractures, clinical, radiological and arthroscopic diagnosis and surgical treatment.

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