Is It Possible to Overcompress the Syndesmosis?

Mahapatra, Piyush; Rudge, Ben; Whittingham-Jones, Paul

doi:10.1053/j.jfas.2017.11.037

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…Moreover, due to the over-compression of the trans-syndesmotic screw, the tibiofibular space becomes too small. If judged simply from the position of the fibula and tibia, it is possible to misjudge the restoration distance [13,14]. Through clinical follow-ups, it was found that syndesmotic malreduction is a factor that may affect ankle function [4,15,16].…”

Section: Discussionmentioning

confidence: 99%

Syndesmotic malreduction may decrease fixation stability: a biomechanical study

et al. 2020

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Background: This study aims to investigate the malreduction of syndesmosis and its effects on stability. Methods: The biomechanical tests, including the three-dimensional (3D) displacement of the syndesmotic incisura, fibular rotation angle, and torque resistance, were performed on six cadaver legs. These specimens were first tested intact (intact group), then cut all the syndesmotic ligaments and fixed in anatomical position (anatomical model group) and test again. After that, syndesmosis was fixed in 1 cm malreduction (anterior and posterior displacement group) to do the same test. Results: In internal or external load, there were significant differences in torque resistance and fibular rotation angle (internal t = 2.412, P = 0.036; external t = 2.412, P = 0.039) between the intact and post-malreduction groups. In internal rotation load, there were significant differences in sagittal displacement between the intact and postmalreduction groups (P = 0.011), and between the anatomical and post-malreduction groups (P = 0.020). In external rotation load, significant differences existed between the intact and ant-malreduction group (P = 0.034) in sagittal (anterior-posterior) displacement. Significant differences also existed between the intact and post-malreduction groups (P = 0.013), and between the anatomical and post-malreduction groups (P = 0.038) in coronal (medial-lateral) displacement.Conclusions: Malreduction in different conditions does affect the stability of the syndesmotic fixation. The result of the study may reveal the biomechanical mechanism of poor clinical outcome in syndesmosis malreduction patients and pathological displacement patterns of the ankle under syndesmotic malreduction conditions. Level of evidence: III

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Section: Discussionmentioning

confidence: 99%

Syndesmotic malreduction may decrease fixation stability: a biomechanical study

et al. 2020

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“…These differences are further increased in plantar flexion. Although previous studies have shown overcompression of the syndesmosis with either fixation method, [37][38][39] this study's protocol allowed for provisional syndesmotic reduction with either a clamp or direct manual pressure. Although reduction method was not recorded in this study, manual pressure or thumb reduction is favored by surgeons at our institution because it is less prone to overcompression than clamp reduction 40 and could explain why greater syndesmotic widths after fixation were observed.…”

Section: Syndesmotic Positionmentioning

confidence: 98%

In Vivo Syndesmotic Motion After Rigid and Flexible Fixation Using 4-Dimensional Computerized Tomography

Wong

Wiens

LaMothe

et al. 2022

Journal of Orthopaedic Trauma

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Introduction: Maintaining reduction after syndesmotic injury is crucial to patient function; however, malreduction remains common. Flexible suture button fixation may allow more physiologic motion of the syndesmosis compared with rigid screw fixation. Conventional syndesmotic imaging fails to account for physiologic syndesmotic motion with ankle range of motion (ROM), providing misleading results. Four-dimensional computerized tomography (4DCT) can image joints through a dynamic ROM. Our purpose was to compare syndesmotic motion after rigid and flexible fixation using 4DCT. Methods:We analyzed 13 patients with syndesmotic injury who were randomized to receive rigid (n = 7) or flexible (n = 6) fixation. Patients underwent bilateral ankle 4DCT while moving between ankle dorsiflexion and plantar flexion. Measures of syndesmotic position and rotation were extracted from 4DCT to determine syndesmotic motion as a function of ankle ROM.Results: Uninjured ankles demonstrated significant decreases in syndesmotic width of 1.0 mm with ankle plantar flexion (SD = 0.6 mm, P , 0.01). Initial rigid fixation demonstrated reduced motion compared with uninjured ankles in 4 of 5 measures (P , 0.01) despite all patients in the rigid fixation group having removed, loose, or broken screws by the time of imaging. Rigid fixation led to less motion than flexible fixation in 3 measures (P = 0.02-0.04). There were no observed differences in syndesmotic position or motion between flexible fixation and uninjured ankles. Conclusion:Despite the loss of fixation in all subjects in the rigid fixation group, initial rigid fixation led to significantly reduced syndesmotic motion. Flexible fixation recreated more physiologic motion compared with rigid fixation and may be used to reduce rates of syndesmotic malreduction.

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“…Several studies and reports have clearly shown that it is possible and even highly likely to over-compress the syndesmosis when using reduction clamps or forceps [26,36,60,82,85,107,121,156]. In this context, over-compression is defined as any sign of displacement of the talus out of the mortise due to compression of the fibula against the tibia even in correct position of the fibula within the incisura.…”

Section: Role Of Reduction Clampsmentioning

confidence: 99%

“…These dangers occur with specific clamp and screw angles in particular. Mahapatra reported that over-compression of the syndesmosis can even cause significant subluxation of the talus [82]. Therefore, care should be taken to avoid over-compression by use of reduction clamps, as this may affect ankle motion and functional outcomes.…”

Section: Role Of Reduction Clampsmentioning

confidence: 99%

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Regauer¹,

Mackay

Nelson

et al. 2022

JCM

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Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

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Is It Possible to Overcompress the Syndesmosis?

Cited by 9 publications

References 11 publications

Syndesmotic malreduction may decrease fixation stability: a biomechanical study

Syndesmotic malreduction may decrease fixation stability: a biomechanical study

In Vivo Syndesmotic Motion After Rigid and Flexible Fixation Using 4-Dimensional Computerized Tomography

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

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