Increased Reduction Clamp Force Associated With Syndesmotic Overcompression

Haynes, J.; Cherney, Steven M.; Spraggs-Hughes, Amanda; McAndrew, Christopher M.; Ricci, William M.; Gardner, Michael J.

doi:10.1177/1071100716634791

Cited by 20 publications

(19 citation statements)

References 27 publications

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“…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.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2017

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BackgroundMalreduction of unstable syndesmotic ankle fractures is common. This study compared the reduction quality of an anterolateral open technique (OT) versus a conventional minimally invasive technique (MIT).MethodsFourteen fresh-frozen lower torso specimens with 28 matched lower extremities underwent computed tomography (CT) to measure syndesmosis position before dissection. Reduction was performed using direct visualization and fluoroscopy for the OT group (right-sided specimens) and fluoroscopy only for the MIT group (left-sided specimens). Fixation was achieved with 2 cortical screws. Measurements were repeated with postfixation CT scans. Statistical analysis used a two-tailed t test (α = 0.05).ResultsMean posterior fibula-tibia distance decreased after OT by 0.3 ± 0.5 mm and increased after MIT by 0.7 ± 0.6 mm (P = 0.025 for difference between techniques). Mean anterior fibula-tibia distance decreased after OT by 0.4 ± 0.2 mm (P = 0.007) and did not change significantly after MIT (− 0.01 ± 0.4 mm (P = 0.686). Mean anterior translation after OT was 0.04 ± 0.4 mm (P = 0.856), and mean posterior translation after MIT was 0.3 ± 0.7 mm (P = 0.434). Mean medialization after OT was 0.3 ± 0.4 mm (P = 0.132), and mean lateralization after MIT was 0.2 ± 0.6 mm (P = 0.446).ConclusionsBoth techniques produced near-anatomic reduction of the fibula, with MIT producing significantly more internal rotation malreduction than OT. OT appears to restore near-anatomic fibula position, although this did not differ significantly from the results of MIT. We conditionally recommend OT when closed reduction of the syndesmosis cannot be obtained.

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Section: Discussionsupporting

confidence: 92%

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

et al. 2017

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“…Previous studies by the senior author (MJG) have sought to promote the safe use of reduction clamps to generate an indirect reduction, by optimizing both proper clamp tine positioning 44 and reduction force. 28 Despite the conclusions in this study, some surgeons will still choose to avoid opening the syndesmosis routinely and are more comfortable with an indirect reduction technique. Additionally, other scenarios (e.g.…”

Section: Discussionmentioning

confidence: 79%

“…Indirect reduction at all positions was performed by a single observer with experience in generating approximately 130 N/m of force with reduction forceps in an effort to standardize the reduction force magnitude. 28 The indirect reduction at each location was performed such that the syndesmosis was not exposed to the observer for visual inspection, nor was there an attempt at radiographic reduction assessment prior to the CT being performed at the specified clamped location. After the specimen was imaged at each clamping position, the screws were removed and the unstable syndesmosis was then reduced using the surgeon’s thumb alone as manual digital pressure, while simultaneously palpating the anterior tibiofibular relationship for congruency.…”

Section: Methodsmentioning

confidence: 99%

A Novel Indirect Reduction Technique in Ankle Syndesmotic Injuries: A Cadaveric Study

Cosgrove

Spraggs-Hughes

Putnam

et al. 2018

Journal of Orthopaedic Trauma

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“…Overcompression is considered to be related to the force of compression applied with a clamp or the position of the ankle joint during reduction. Haynes et al (17) demonstrated a significant correlation between increased clamp force and syndesmotic overcompression and determined the objective forces that lead to overcompression. Abbreviations: BMI, body mass index; PER, pronation external rotation; SER, supination external rotation.…”

Section: Discussionmentioning

confidence: 99%

“…Although most institutions have enough instruments, concern exists regarding the availability of these items. In addition, overcompression was frequently observed with the use of a reduction clamp (9,17). Although Tornetta et al (18) found no limitation in ankle dorsiflexion despite maximum syndesmotic overcompression in a cadaveric study, the clinical result of this observation is uncertain.…”

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confidence: 99%

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

Park

Ahn

Choi

et al. 2018

The Journal of Foot and Ankle Surgery

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An optimal outcome of surgical treatment for a syndesmotic injury depends on accurate reduction and adequate fixation. It has been suggested that the use of a reduction clamp for reduction of the syndesmosis results in better reduction and a lower rate of redisplacement than manual reduction. However, these concepts have never been scientifically evaluated. We compared these 2 methods in a prospective randomized trial. A total of 85 acute ankle rotational fractures combined with syndesmotic injury were randomized to syndesmosis reduction with either a reduction clamp or manual manipulation. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space immediately postoperatively and at the final follow-up examination. Ankle joint range of motion, visual analog scale score, Olerud-Molander ankle scoring system, and complications were obtained at the last follow-up visit to assess the clinical outcomes. Of the 3 radiographic measurements, the tibiofibular clear space and tibiofibular overlap differed significantly between the 2 groups (p < .05). The clinical outcomes did not differ significantly between the 2 groups (p > .05). Although differences were found in the radiographic measurements, most syndesmoses in both groups were within the normal range at the final follow-up visit, and the 2 methods of syndesmosis reduction provided similar clinical outcomes. Accordingly, the results of the present study suggest that both of these methods are effective and reliable for reduction of the syndesmosis in rotational ankle fractures.

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Increased Reduction Clamp Force Associated With Syndesmotic Overcompression

Abstract: Level III, case-control series, in accordance with STROBE guidelines.

Cited by 20 publications

References 27 publications

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

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

A Novel Indirect Reduction Technique in Ankle Syndesmotic Injuries: A Cadaveric Study

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

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