Effect of Ankle Position on Tibiotalar Motion With Screw Fixation of the Distal Tibiofibular Syndesmosis in a Fracture Model

Pallis, Mark; Pressman, David N; Heida, Kenneth A.; Nicholson, Tyler C.; Ishikawa, Susan N.

doi:10.1177/1071100718759966

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…According to a previous classic study, plantarflexion of the ankle during syndesmotic screw placement leads to a decrease in dorsiflexion capacity 24 . However, other authors argued that there was no need to keep the ankle in maximal dorsiflexion when inserting the screw because they observed no significant relationship between the change in maximal dorsiflexion and ankle position 25 . van Zuuren et al 2 .…”

Section: Discussionmentioning

confidence: 99%

“…24 However, other authors argued that there was no need to keep the ankle in maximal dorsiflexion when inserting the screw because they observed no significant relationship between the change in maximal dorsiflexion and ankle position. 25 van Zuuren et al 2 concluded that the most important aspect of syndesmotic fixation was the anatomical reduction of the syndesmosis and the ankle's position during fixation was ultimately not important. Therefore, further research is required to examine this question.…”

Section: Restrictions In Range Of Motionmentioning

confidence: 99%

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Does the Level of Syndesmotic Screw Insertion Affect Clinical Outcome after Ankle Fractures with Syndesmotic Instability?

Chen

et al. 2022

Orthopaedic Surgery

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Objective: Ankle fractures are often combined with syndesmotic instability, requiring reduction and stabilization. However, the optimal level for syndesmotic screw positioning remains unclear. This study aims to evaluate the effect of different syndesmotic screw insertion levels on postoperative clinical outcomes and determine whether an optimal level exists.Methods: This retrospective study included data from 43 adult patients with acute closed ankle fractures combined with intraoperative evidence of unstable syndesmotic injuries who underwent open reduction internal fixation from January 1, 2017 to March 1, 2018 according to the inclusion and exclusion criteria. All 43 patients were divided into three groups based on the syndesmotic screw placement level: trans-syndesmotic group: screw level of 2-3 cm; inferior-syndesmotic group: screw level <2 cm; and supra-syndesmotic group: screw level >3 cm. Clinical outcomes were measured at the final follow-up, including the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Olerud-Molander Ankle Score (OMAS), short-form 36-item questionnaire (SF-36), visual analogue scale (VAS) score and restrictions in ankle range of motion (ROM). The relationships between screw placement level and clinical outcomes were analyzed with the Kruskal-Wallis H-test and Spearman correlation analysis. Results:The median follow-up duration was 15 months (range, 10-22 months). No patients developed fracture nonunion or malunion or experienced hardware failure. The outcome scoring systems showed an overall score for the entire group of 94.91 points for the AOFAS ankle-hindfoot score, 83.14 for the OMAS, 96.65 for the SF-36, 1.77 for the VAS, 9.14 for the restrictions in dorsiflexion, and 1.30 for the restrictions in plantarflexion. There were no significant differences among three groups in clinical outcomes (P > 0.05). Neither the AOFAS score nor OMAS had significant correlations with screw insertion level (P = 0.825 and P = 0.585, respectively). No postoperative arthritis or widening of the tibiofibular space was observed at the final follow-up. Conclusion:Different syndesmotic screw placement levels appear not to affect the clinical outcomes of ankle fractures with syndesmotic instability. No optimal level was observed in this study. Our findings suggest other clinically acceptable options apart from syndesmotic screw placement 2-3 cm above the ankle.

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Section: Discussionmentioning

confidence: 99%

Section: Restrictions In Range Of Motionmentioning

confidence: 99%

Does the Level of Syndesmotic Screw Insertion Affect Clinical Outcome after Ankle Fractures with Syndesmotic Instability?

Chen

et al. 2022

Orthopaedic Surgery

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“…However, in later cadaver studies, it was shown that ankle position during fixation did not affect motion. [ 26 ] Orthopedic surgeons are still confused between the previous and relatively new evidences.…”

Section: Discussionmentioning

confidence: 99%

Is there any change in surgeon’s attitude to the management of ankle fractures accompanying syndesmotic injury? A nationwide survey

et al. 2020

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“…2,3,14 However, several complications of screw fixation, such as screw loosening, breakage, local irritation, and discomfort, are reported for this rigid fixation. 5,18,21,27 Malreduction of syndesmosis has also been noted as a significant problem, and its incidence has been found to be 20.8% to 52% on postoperative CT scans. 9,15,19 The dynamic suture-button technique has increased in popularity because it restores physiological movement while providing more accurate reduction and more satisfactory outcomes than other techniques.…”

Section: Introductionmentioning

confidence: 99%

A Novel Flexible Fixation Method for Syndesmotic Injury

Dong

Wang

et al. 2023

Foot Ankle Int.

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Background: This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the “embrace” technique. Methods: Between March 2018 and October 2020, a total of 67 patients with ankle fractures and syndesmotic injuries underwent syndesmosis fixation with the embrace technique at our institute. Plain radiographs and computed tomographic (CT) scans were obtained preoperatively. Postoperative radiographic assessment included anteroposterior (AP) and lateral radiographs and CT scans of both ankles. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Olerud-Molander Ankle Score, and visual analog scale (VAS) score were used for postoperative assessment. Results: The mean age was 27.6 ± 10.9 (range, 14-56) years. The mean follow-up time was 30.3 ± 6.2 (range, 24-48) months. There were no malreductions indicated by any CT parameter except fibular rotation in a postoperative comparison between 2 sides. We found significant preoperative-postoperative changes in anterior difference, posterior difference, and fibular rotation but no significant preoperative-postoperative difference in fibular translation. There was no significant postoperative difference between the affected-side and normal-side measurements of any parameter. Complications included delayed wound healing, lateral pain because of wire knot irritation (11.9%), and medial fiber wire irritation (7.5%). The mean AOFAS, Olerud-Molander, and VAS scores at the last follow-up were 94.4 ± 6.8 (range, 84-100), 95.4 ± 6.1 (range, 80-100), and 0.68 ± 1.0 (range, 0-3) points, respectively. Conclusion: In our cohort, this novel technique proved to be an effective method for syndesmosis fixation in patients with ankle fractures associated with very good radiologic and patient-reported outcomes. Level of Evidence: Level IV, case series.

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Effect of Ankle Position on Tibiotalar Motion With Screw Fixation of the Distal Tibiofibular Syndesmosis in a Fracture Model

Abstract: Our findings suggest that maximal dorsiflexion during syndesmotic screw fixation may not be necessary.

Cited by 13 publications

References 21 publications

Does the Level of Syndesmotic Screw Insertion Affect Clinical Outcome after Ankle Fractures with Syndesmotic Instability?

Does the Level of Syndesmotic Screw Insertion Affect Clinical Outcome after Ankle Fractures with Syndesmotic Instability?

Is there any change in surgeon’s attitude to the management of ankle fractures accompanying syndesmotic injury? A nationwide survey

A Novel Flexible Fixation Method for Syndesmotic Injury

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