Management of Syndesmotic Disruption in Ankle Fractures

Scolaro, John A.; Marecek, Geoffrey S.; Barei, David P.

doi:10.2106/jbjs.rvw.n.00028

Cited by 7 publications

(2 citation statements)

References 90 publications

(86 reference statements)

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“…Iatrogenic damage to this joint may explain some of the poor outcomes seen after syndesmotic fixation. 16,23,27,31 Several articles have described the tibiofibular contact zone at the base of the syndesmosis, and identify this articulation as a distinct synovial-lined joint with articular cartilage. 1,4,5,9,10,17,28,35,36 The syndesmotic recess is a synovial-lined plica that extends from the tibiotalar joint proximally to the distal insertional fibers of the interosseous tibiofibular ligaments.…”

Section: Discussionmentioning

confidence: 99%

Articular Cartilage of the Syndesmosis: Avoiding Iatrogenic Cartilage Injury During Syndesmotic Fixation

et al. 2021

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Background: The optimal surgical management of syndesmosis injuries consists of internal fixation between the distal fibula and tibia. Much of the available data on this joint details the anatomy of the syndesmotic ligaments. Little is published evaluating the distribution of articular cartilage of the syndesmosis, which is of importance to minimize the risk of iatrogenic damage during surgical treatment. The purpose of this study is to describe the articular cartilage of the syndesmosis. Methods: Twenty cadaveric ankles were dissected to identify the cartilage of the syndesmosis. Digital images of the articular cartilage were taken and measured using calibrated digital imaging software. Results: On the tibial side, distinct articular cartilage extending above the plafond was identified in 19/20 (95%) specimens. The tibial cartilage extended a mean of 6 ± 3 (range, 2-13) mm above the plafond. On the fibular side, 6/20 (30%) specimens demonstrated cartilage proximal to the talar facet, which extended a mean of 24 ± 4 (range, 20-31) mm above the tip of the fibula. The superior extent of the syndesmotic recess was a mean of 10 ± 3 (range, 5-17) mm in height. In all specimens, the syndesmosis cartilage did not extend more than 13 mm proximal to the tibial plafond and the syndesmotic recess did not extend more than 17 mm proximal to the tibial plafond. Conclusion: Syndesmosis fixation placed more than 13 mm proximal to the tibial plafond would have safely avoided the articular cartilage in all specimens and the synovial-lined syndesmotic recess in most. Clinical Relevance: This study details the articular anatomy of the distal tibiofibular joint and provides measurements that can guide implant placement during syndesmotic fixation to minimize the risk of iatrogenic cartilage damage.

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Section: Discussionmentioning

confidence: 99%

Articular Cartilage of the Syndesmosis: Avoiding Iatrogenic Cartilage Injury During Syndesmotic Fixation

et al. 2021

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“…The anatomical restoration of fibular length, alignment and rotation is important for accurate syndesmotic reduction [8] . The present study suggests anatomical reduction of the fracture and restoration of the joint congruity of the ankle at the earliest.…”

Section: Discussionmentioning

confidence: 99%

Fibula hook plate as an excellent implant of choice for lateral malleolar fracture

Handralmath¹,

Kalambe²,

Das³

2017

Int. J. Orthop. Sci.

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Fractures involving the ankle are one of the most common injuries treated by orthopedic surgeons. The anatomy of the joint makes it very unstable in cases of fractures or ligamentous injuries of the ankle. As fractures of the ankle have been treated with various modes of internal fixation devices, the best possible implant is determined according to the anatomy of the fracture. Various internal fixation devices like interfragmentary screw, reconstruction plate, tubular plate have been used for lateral malleolus fracture. We studied the use of fibula hook plate for lateral malleolus fracture. Total 40 patients were studied and were followed up post-operatively after 3 months, 6 months and 12 months. The fractures were classified according to the Lauge-Hansen classification system. Ankle score for symptom evaluation of ankle fracture by C. Olerud and H. Molander was calculated. Radiological evaluation was done by Kristenson's criteria. Out of 40 patients, 10 patients had excellent outcome and 19 patients had good outcome. Eight patients showed fair results whereas three patients had poor results. No intra-operative complication was observed. Post-operatively six patients developed skin infection. Anatomical reduction of ankle fractures is very important for normal weight bearing stress. The length of fibula must be maintained for this purpose. Hook plate helps to achieve this by holding the reduction of lateral malleolar fragment.

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