Comparison of Clamp Reduction and Manual Reduction of Syndesmosis in Rotational Ankle Fractures: A Prospective Randomized Trial

Park, Young Hwan; Ahn, Jeong Hwan; Choi, Gi Won; Kim, Soo Hyun

doi:10.1053/j.jfas.2017.05.040

Cited by 19 publications

(15 citation statements)

References 31 publications

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“…This process often utilizes compressive clamping across the syndesmosis, 9 which can malreduce and/or overcompress the syndesmosis. 19 The use of a calibrated syndesmotic reduction clamp in this work resulted in well-controlled load application along specific transsyndesmotic vectors. Under these conditions, it was found that when the medial tine of the clamp was positioned anterior to the midline of the medial tibia, progressively increasing clamp force caused little fibular malalignment relative to the tibia.…”

Section: Discussionmentioning

confidence: 96%

Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping

et al. 2019

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Background: Fibular malreduction is becoming a commonly recognized complication of surgical repair of the syndesmosis when a reduction clamp is used. The goal of this work was to determine the interdependent effects of transsyndesmotic reduction clamp position and applied compression force on fibular alignment in a realistic cadaveric preparation of complete syndesmotic injury. Methods: Six through-the-knee cadaveric specimens were CT scanned intact, with the distal syndesmosis fully destabilized, and with 53, 102, and 160 N clamping forces each applied along an anteriorly, centrally, and posteriorly directed transsyndesmotic axis. Testing was repeated incorporating 178 N of Achilles tendon tension using all 3 clamping forces applied along the centrally directed axis. Fibular reduction was automatically quantified from CT scan–generated bony surfaces as rotation of the fibula around the tibia, rotation of the fibula within the incisura, medial/lateral fibular displacement, and anterior/posterior fibular displacement. Results: Transsyndesmotic clamping along the anteriorly directed axis resulted in the best reduction quality by all 4 quantified measures. Along the centrally and posteriorly directed axes, progressively greater forces caused significantly greater sagittal plane fibular malreduction. Addition of Achilles tension reduced the magnitude of fibular malreduction and overcompression. Conclusion: Placing the medial tine of a transsyndesmotic reduction clamp on the anterior medial tibia resulted in the most accurate syndesmotic reduction and provided some protection against overcompression with large reduction clamp forces. Achilles tension appeared to contribute to reduction, decreasing the magnitude of measured malreduction from clamping. Clinical relevance: Previous studies estimating fibular malpositioning in cadaveric models that lacked passive muscle tension may have overestimated expected magnitudes of malalignment in patients treated with syndesmotic clamping. However, syndesmotic malreduction, particularly in the sagittal plane, was a real complication of syndesmotic clamping that was reduced by using an anterior position of the medial tine on the tibia.

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Section: Discussionmentioning

confidence: 96%

Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping

et al. 2019

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“…Recently, the most common intraoperative reduction technique for injuries of the syndesmotic region is the conventional bone reduction forceps. Nevertheless, prospective studies have shown that the manual reduction technique is comparable 24 .…”

Section: Discussionmentioning

confidence: 99%

“…The most common reduction method in the operative treatment of unstable syndesmotic injuries is the conventional bone reduction forceps. Nevertheless, prospective studies have shown that the manual reduction technique is comparable 24 . There are no studies on the collinear reduction clamp for unstable ankle injuries, but good reduction results have been demonstrated in other fracture regions such as the acetabulum 25 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of three different reduction methods of the ankle mortise in unstable syndesmotic injuries

Vetter

Beisemann

Keil

et al. 2019

Sci Rep

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In order to achieve a clinically satisfying result and to prevent posttraumatic osteoarthritis in the treatment of unstable syndesmotic injuries, anatomically correct reduction is crucial. The objective of the study was to investigate three different reduction methods of the ankle mortise in unstable syndesmotic injuries. In a specimen model with 38 uninjured fresh-frozen lower legs, a complete syndesmotic dissection was performed. The ankle mortise was reduced with either a collinear reduction clamp, a conventional reduction forceps or manually with crossing K-wires. The reduction clamps and the K-wires were placed in a 0°-angle to the leg axis. The clamps were positioned on the posterolateral ridge of the fibula 20 mm proximal to the ankle joint line. A cone beam computed tomography was performed after dissection and after each reduction. Tibio-fibular distances and angles were determined. Despite significant differences in terms of overcompression (0.09–0.33 mm; p = 0.000–0.063) and the slight external rotation (0.29–0.47°; p = 0.014–0.07), the results show a satisfying reduction of the ankle mortise. There were no considerable differences between the reduction methods. It can therefore be concluded that the ankle mortise can be reduced with any of the methods used, but that the positioning and the contact pressure must be considered.

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“…The hook test was defined as positive if >2 mm of lateral fibula movement was observed. 23 In cases where syndesmosis injury was present and the hook test was positive, syndesmosis transfixation was performed at 2 to 3 cm above the ankle joint using a 3.5-mm cortical screw.…”

Section: Methodsmentioning

confidence: 99%

Necessity of Interfragmentary Lag Screws in Precontoured Lateral Locking Plate Fixation for Supination-External Rotation Lateral Malleolar Fractures

2020

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Background: Interfragmentary lag screws, protected by a plate, have been applied for many years in the treatment of supination-external rotation (SER) ankle fractures. Recently, similar biomechanical stability was found between fixation completed with a plate and lag screw and a plate alone. The aim of this study was to determine whether interfragmentary lag screws are necessary during precontoured lateral locking plate fixation for SER lateral malleolar fractures. Methods: A prospective randomized controlled trial of 76 patients with unilateral Lauge-Hansen SER lateral malleolar fractures was conducted. The patients were randomly treated either with or without the use of interfragmentary lag screws with precontoured lateral locking plate fixation. Clinical outcomes were assessed using the Olerud-Molander Ankle Score and a visual analog scale for pain. Radiologic outcomes were assessed based on the Kellgren and Lawrence scale score, incongruity of the ankle joint, and type of fracture healing. Sixty-nine patients completed 12 months of follow-up. Results: There was no significant difference between the 2 groups with regard to clinical outcomes at 3 and 12 months after surgery and radiologic outcomes at 12 months after surgery. All patients in both groups achieved primary bone healing. Conclusion: The results of this study suggest that with precontoured lateral locking plate fixation, the use of interfragmentary lag screw is not essential in the treatment SER lateral malleolar fractures. Level of Evidence: Level I, prospective randomized study.

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Comparison of Clamp Reduction and Manual Reduction of Syndesmosis in Rotational Ankle Fractures: A Prospective Randomized Trial

Cited by 19 publications

References 31 publications

Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping

Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping

Comparison of three different reduction methods of the ankle mortise in unstable syndesmotic injuries

Necessity of Interfragmentary Lag Screws in Precontoured Lateral Locking Plate Fixation for Supination-External Rotation Lateral Malleolar Fractures

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