Malreduction of syndesmosis injury associated with malleolar ankle fracture can be avoided using Weber's three indexes in the mortise view

Futamura, Kentaro; Baba, Tomonori; Mogami, Atsuhiko; Morohashi, Itaru; Kanda, Akio; Obayashi, Osamu; Satō, Kazuo; Ueda, Yasuhisa; Kurata, Yoshiaki; Tsuji, Hideki

doi:10.1016/j.injury.2017.02.004

Cited by 32 publications

(17 citation statements)

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“…Weber's three indexes were used to evaluate reduction of the ankle joint and syndesmosis in the mortise view: (1) trilateral intervals of the ankle joint should be equal and parallel, (2) the medial spike of the fibula should indicate the level of the tibial subchondral bone (no irregular Shenton's line), and (3) the contour of the lateral part of the articular surface of the talus continues as an unbroken curve to the recess in the distal fibula (Coin sign). [ 23 24 ] The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Visual Analog Scale (VAS) score were used for functional and pain evaluation at the final follow-up of a mean of 3 years.…”

Section: Ethodsmentioning

confidence: 99%

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws

Lai

et al. 2018

Chinese Medical Journal

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Background:In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type of pronation-external rotation (PER) fractures with supracollicular medial malleolar (SMM) fractures. This study was designed to assess the 3-year functional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies.Methods:This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients (Group 1) were treated without a supplemental syndesmotic screw fixation, according to the negative intraoperative stress test after bony fixation, while 32 patients (Group 2) were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Visual Analog Scale (VAS) for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and one-way analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models.Results:We observed no difference in the distribution of age, sex, presence of associated posterior malleolus (PM), fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS (Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27) and VAS (Group 1 vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P = 0.12) in association with two strategies.Conclusions:The present study indicates no difference to the use of the syndesmotic screw in terms of the functional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fracture patients with SMM fracture after 3-year follow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.

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Section: Ethodsmentioning

confidence: 99%

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws

Lai

et al. 2018

Chinese Medical Journal

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“…The data in this study extracted mainly included the general or basic information of studies (the publication year, the first author, the patient numbers, the gender and age of patients, the follow-up duration and the study design), the Olerud-Molander (OM) score (≥12 months postoperatively), the ankle-hindfoot score of the American Orthopedic Foot and Ankle Society (AOFAS), and the number of syndesmotic malreductions, overall complications, and second procedures. Malreduction of syndesmosis was defined as a difference in syndesmosis width of more than 2 mm compared with the untreated contralateral ankle, as measured on an axial computed tomography scan [35]. Second procedure was defined as another surgical operation conducted after the index operation, and these second procedures included revision surgery and hardware removal.…”

Section: Methodsmentioning

confidence: 99%

Dynamic Fixation Versus Static Fixation for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Gan

Zhou

et al. 2019

Med Sci Monit

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Background Ankle sprains with distal tibiofibular syndesmosis injuries (DTSIs) require anatomic reduction and fixation to restore the normal biomechanics of the ankle joint. In the last decade, dynamic fixation (DF) for DTSIs using a suture-button device has gained popularity because of its advantages over static fixation (SF). Material/Methods The present meta-analysis was conducted to compare clinical outcomes between DF and SF of DTSIs. PubMed, Cochrane Central Register of Controlled Trials, and Embase were systematically searched. Three randomized controlled studies and 7 cohort studies, with a total of 420 patients, were involved in this study. DTSIs patients treated with DF were assigned to the experimental group, and patients treated with SF were assigned to the control group. Outcomes were evaluated and analyzed by using review-manager software. Mean difference (MD) or risk ratio (RR) with 95% confidence interval (95% CI) was analyzed and calculated by utilizing the random effects models. Results Analysis revealed no statistically significant differences between DF and SF in American Orthopedic Foot and Ankle Society Ankle-Hindfoot score (MD, 1.90; 95% CI, −0.23–4.03; p =0.08; I 2 =0%), Olerud-Molander score (MD, 1.92; 95% CI, −7.96–11.81; p =0.70; I 2 =55%), incidence of syndesmotic malreduction (RR, 0.19; 95% CI, 0.03–1.09; p =0.06; I 2 =0%), and overall postoperative complication rate (RR, 0.30; 95% CI, 0.09–0.99; p =0.05, I 2 =75%). The rate of second procedure was significantly lower compared with DF (RR, 0.17; 95% CI, 0.07–0.43; p =0.0002, I 2 =54%). Conclusions The dynamic fixation and static fixation methods are equal in clinical outcomes, with dynamic fixation needing fewer second interventions for DTSIs.

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“…Firstly, syndesmosis mal-reduction is more common than previously thought (up to 30% in some studies) if postoperative CT scanning is used for evaluation. 45 Therefore, many surgeons advocate open (not percutaneous) reduction of the syndesmosis before fixation. Arthroscopic evaluation is an alternative, to ensure reduction of the fibula into the incisura.…”

Section: Treatmentmentioning

confidence: 99%

Stability in ankle fractures

2018

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Medial column (deltoid ligament) integrity is of key importance when considering the stability of isolated lateral malleolus ankle fractures.Weight-bearing radiographs are the best method of evaluating stability of isolated distal fibula fractures.Computed tomography (CT) scanning is mandatory for the assessment of complex ankle fractures, especially those involving the posterior malleolus.Most isolated trans-syndesmotic fibular fractures (Weber-B, SER, AO 44-B) are stable and can safely be treated non-operatively.Posterior malleolus fractures, regardless of size, should be considered for surgical fixation to restore stability, reduce the need for syndesmosis fixation, and improve contact pressure distribution.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170057

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Malreduction of syndesmosis injury associated with malleolar ankle fracture can be avoided using Weber's three indexes in the mortise view

Cited by 32 publications

References 32 publications

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws

Dynamic Fixation Versus Static Fixation for Distal Tibiofibular Syndesmosis Injuries: A Meta-Analysis

Stability in ankle fractures

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