Fixation Techniques in Lower Extremity Syndesmotic Injuries

D’Hooghe, Pieter; York, Philip J.; Kaux, Jean-François; Hunt, Kenneth J.

doi:10.1177/1071100717735639

Cited by 19 publications

(34 citation statements)

References 71 publications

(115 reference statements)

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“…Although the incidence of isolated syndesmosis injury among professional football players is low, existing data suggest it causes a mean time loss of 39 days and an injury burden of 1.8 days absence per/1000 hours of exposure 1 2. Current treatment algorithms subdivide syndesmotic injury based on MRI findings (tear of the antero-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL) and postero-inferior tibiofibular ligament (PITFL)) (figure 1) and physical examination (squeeze test and external rotation stress test) 3–8…”

Section: Introductionmentioning

confidence: 99%

“…Based on MRI findings syndesmosis injury can be classified as West Point grade I (sprain of AITFL) and West Point grade III (complete disruption of all syndesmotic ligaments with frank diastasis) 5. MRI findings for West Point grade IIA (stable) and IIB (unstable) include complete tear of the AITFL and injury of the IOL and are differentiated based on a positive squeeze test.…”

Section: Introductionmentioning

confidence: 99%

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Return to play after surgery for isolated unstable syndesmotic ankle injuries (West Point grade IIB and III) in 110 male professional football players: a retrospective cohort study

et al. 2019

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ObjectivesTo evaluate time to return to play following surgical stabilisation of isolated unstable syndesmosis injuries in a cohort of professional male football players.MethodsAll professional football players undergoing surgery for isolated unstable syndesmosis injury (West Point grade ≥IIB) at a specialised Orthopaedic and Sports Medicine Hospital were followed up until return to play (minimum ≥6 months). Players with a stable syndesmosis, injuries older than 6 weeks, concomitant medial or lateral malleolar fracture or previous ankle surgery were excluded. During rehabilitation, time required to return to sports-specific rehabilitation, team training and first match play, were recorded.ResultsBetween January 2012 and December 2017, a total of 110 male professional football players were included. The mean time required to begin on field rehabilitation was 37±12 days, while the mean time to return to team training was 72±28 days. The first official match was played on average 103±28 days postoperatively. Multivariable analysis revealed that the severity of injury, the concomitant presence of talar cartilage injury and the age of the player were significantly associated (p<0.00001) with time to return to on field rehabilitation, team training and match play.ConclusionIn this cohort of professional football players, surgical stabilisation of isolated unstable syndesmosis injuries (West Point grade ≥IIB) allowed for relatively quick return to play. High grade injury (West Point grade III), concomitant cartilage injury and greater age were associated with longer return to play times.Level of evidenceLongitudinal observational cohort study (level II).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Return to play after surgery for isolated unstable syndesmotic ankle injuries (West Point grade IIB and III) in 110 male professional football players: a retrospective cohort study

et al. 2019

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“…So far, a stage 4 PE injury is developed [6,13,14,25]. In the literature, either injury is regarded as frankly or potentially unstable and surgical treatment is normally necessary [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…From January 1, 2008 to December 31, 2017, 822 consecutive adult patients (> 18 years) who sustained malleolar fractures with or without SD and had been surgically treated were traced for this study. All ankle injuries were classi ed based on combined Weber and Lauge-Hansen classi cations [4,6,7]. Ninety-nine cases were grouped as advanced pronation injuries (PE or pronation-abduction injuries) and 81 advanced PE injuries were enrolled in the present study.…”

Section: Subjectsmentioning

confidence: 99%

“…Until now, no any classi cation is convincingly acknowledged to be applicable for all ankle injuries. Clinically, combined Weber and Lauge-Hansen classi cations had been widely used to treat complex ankle injuries by many supporters [4,6,7]. They believed that the combined classi cations can comprise the majority of common and important ankle injuries.…”

Section: Introductionmentioning

confidence: 99%

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Should the Diastatic Syndesmosis be Stabilized in Advanced Pronation-External Rotation Ankle Injuries? A Retrospective Cohort Comparison

Wu¹,

Yeh²,

Lee³

et al. 2020

Preprint

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Background: Ankle injuries with the advanced pronation-external rotation (PE) type are relatively uncommon and the debate about whether the diastatic syndesmosis should be stabilized concomitantly has yet achieved a consensus. Comparison of using (Group 1) or non-using (Group 2) screw stabilization for the diastatic syndesmosis was performed retrospectively. Methods: With the 10-year period, 81 consecutive adult patients with advanced PE ankle injuries (stage 3 or 4 PE type) were treated. After malleolar fractures were internally stabilized with screws and plates, the syndesmotic stability was re-checked by external rotation and hook tests. The necessity of insertion of cortical screws to stabilize diastatic syndesmosis was decided by the individual orthopedic surgeon. The outcomes of both approaches were compared. Results: Seventy-one patients were followed for at least one year (87.7%; average, 2 years; range, 1-11 years). Group 1 had 22 patients and Group 2, 49 patients. The union rate in Group 1 was 100% (22 / 22) and in Group 2, 91.8% (45 / 49; p= 0.30). Syndesmosis re-diastasis occurred in 13.6% (3 / 22) of Group 1 and 30.6% (15 / 49) of Group 2 (p= 0.13). Satisfactory ankle function was noted in 86.4% (19 / 22) of Group 1 and 65.3% (32 / 49) of Group 2 (p= 0.07). Conclusion: Although clinical comparison cannot demonstrate statistical difference, screw stabilization of the diastatic syndesmosis may guarantee safer results. The statistical insignificance may be due to insufficient sample sizes. Clinically and theoretically, insertion of syndesmotic screws to promote ligament healing may be reasonable.

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