In Vivo Syndesmotic Overcompression After Fixation of Ankle Fractures With a Syndesmotic Injury

Abstract

Objectives The goals of this study were to assess syndesmotic reductions utilizing computerized tomography (CT) scans, and to determine if malreductions were associated with certain injury types or reduction forceps. Design Prospective cohort Setting Urban Level 1 Trauma center Patients Twenty-seven patients with operatively treated syndesmotic injuries were recruited prospectively. Intervention Patients underwent postoperative bilateral CT scans of the ankle and hindfoot to assess syndesmotic reduction. The uninjured extremity was used as a control. Main outcome measurement Side-to-side differences of fibula position within the tibial incisura were measured at several anatomic points and analyzed based on injury type, the presence of posterior malleolar injury, level of fracture, and type of reduction forceps used. Results On average, operatively treated syndesmotic injuries were over-compressed (fibular medialization) by 1mm (p < .001) and externally rotated by 5° (p = .002) when compared to the uninjured extremity. The absence of a posterior malleolar injury and Weber B (OTA 44-B) fractures seemed to have a protective effect against malrotation, but not against over-compression. There was no difference in malreduction based on type of clamp used. Conclusions It is possible, and highly likely based on these data, to over-compress the syndesmosis when using a reduction forceps. Care should be taken to avoid over-compression, as this may affect ankle motion and functional outcome. This is the first in vivo series of syndesmotic over-compression to our knowledge.

Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model

“…This suggests that there was a net compression effect or medial translation, rather than rotational malreduction. This finding is consistent with studies by Haynes et al [ 28 ] and Cherney et al [ 29 ] that showed overcompression was likely during reduction clamping of the syndesmosis, with a mean of 1 mm of overcompression and 5° of external rotation. Similar results were found in a cadaveric study by Phisitkul et al [ 25 ], which showed a mean syndesmosis displacement of 0.1 ± 0.77 mm in all degrees of instability and overcompression of 0.93 ± 0.70 mm during clamping, with the clamp in the neutral anatomical axis.…”

3D Model Analysis of Ankle Flexion on Anatomic Reduction of a Syndesmotic Injury

“…Multiple biomechanical and clinical studies have demonstrated that medial overcompression of the distal tibiofibular articulation is possible during operative fixation. 3,13,17,21 Cherney et al 3 reported in a prospective study that 44% of patients (12/27) had significant postoperative fibular medialization relative to the contralateral side following syndesmotic reduction and quadcortical screw fixation. Hayes et al 13 investigated the amount of force applied during clamp reduction during syndesmotic repair in a case-control series.…”

Increased Reduction Clamp Force Associated With Syndesmotic Overcompression

“…16,19 Recent data from our institution revealed that 12 of 27 patients (44%) treated with syndesmotic reduction and fixation had excessive medialization of the fibula by greater than 1.0 mm when compared with the contralateral uninjured ankle on postoperative CT scan. 5 Overcompression of the syndesmosis may limit physiologic ankle motion, affect functional and subjective outcomes, and possibly contribute to accelerated chondrosis and eventual osteoarthritis.…”