Mechanical considerations for the syndesmosis screw. A cadaver study.

Boden, Scott D.; Labropoulos, Panos A.; McCowin, Philip R.; Lestini, William F.; Hurwitz, Shepard R.

doi:10.2106/00004623-198971100-00014

Cited by 235 publications

(116 citation statements)

References 25 publications

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“…Studies by Michelson and Waldman 34 and Boden et al 8 also support the importance of the deltoid ligament in stabilizing the distal tibiofibular articulation. Michelson and Waldman 34 modeled external rotation injury loads to the syndesmosis under various conditions involving sectioning of the interosseous ligament, transection of the superficial and deep portions of the deltoid ligament, and fibular osteotomy.…”

Section: Cadaver Studiesmentioning

confidence: 77%

“…Based on cadaveric studies, syndesmotic screw fixation may be needed only if the deltoid ligament is torn or with malleolar fractures. 8,58 Miller et al 35 treated patients with lateral talus subluxation greater than 1 mm by reduction combined with a 4.5-mm, single syndesmosis screw rather than with cast immobilization. Miller et al 35 propose that surgical repair assures reduction of the injury and stability of the ankle mortise.…”

Section: Clinical Interventionmentioning

confidence: 99%

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Ankle Syndesmosis Injuries: Anatomy, Biomechanics, Mechanism of Injury, and Clinical Guidelines for Diagnosis and Intervention

Lin

Gross

Weinhold

2006

J Orthop Sports Phys Ther

178

149

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Syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. The purpose of this clinical commentary is to review the mechanisms of syndesmotic injuries, clinical examination methods, diagnosis, and management of the injuries. Cadaveric studies of the syndesmosis and deltoid ligaments are also reviewed for further understanding of stress transmission and the roles of different structures in stabilizing the distal syndesmosis. External rotation and excessive dorsiflexion of the foot on the leg have been reported as the most common mechanisms of injury. The injury is most often incurred by individuals who participate in skiing, football, soccer, and other sport activities played on turf. The external rotation and squeeze tests are reliable tests to detect this injury. The ability of imaging studies to assist in an accurate diagnosis may depend on the severity of the injury. The results of cadaveric studies indicate the importance of the deltoid ligament in maintaining stability of the distal tibiofibular syndesmosis and the congruency of the ankle mortise. Intervention programs with early rigid immobilization and pain relief strategies, followed by strengthening and balance training are recommended. Heel lift and posterior splint intervention can be used to avoid separation of the distal syndesmosis induced by excessive dorsiflexion of the ankle joint. Application of a rigid external device should be used with caution to prevent medial-lateral compression of the leg superior to the ankle mortise, thereby inducing separation of the distal syndesmosis articulation. Surgical intervention is an option when a complete tear of the syndesmotic ligaments is present or when fractures are observed.

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Section: Cadaver Studiesmentioning

confidence: 77%

Section: Clinical Interventionmentioning

confidence: 99%

Ankle Syndesmosis Injuries: Anatomy, Biomechanics, Mechanism of Injury, and Clinical Guidelines for Diagnosis and Intervention

Lin

Gross

Weinhold

2006

J Orthop Sports Phys Ther

178

149

View full text Add to dashboard Cite

show abstract

“…The average follow-up period was 13.4 months (range, [11][12][13][14][15][16][17]. The Olerud-Molander ankle scoring system was used to assess postoperative ankle function.…”

Section: Follow-upmentioning

confidence: 99%

“…In 1987, Baird and Jackson found that treatment of the deltoid ligament with suturing could achieve good results in patients with supinationexternal rotation type IV injuries 12 . Boden et al concluded that the medial deltoid ligament was the primary structure for ankle stability 13 . Thus, Maynou et al suggested that exploration and ligament repair in the medial interval should be performed in patients with a medial interval greater than 3 mm 14 .…”

Section: Management Of Acute Deltoid Ligament Injurymentioning

confidence: 99%

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination‐External Rotation Type IV Ankle Fractures

Wang

Zhang

Yin

et al. 2017

Orthopaedic Surgery

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Objective: To investigate the effect of internal fixation on postoperative ankle function in patients with supinationexternal rotation type IV ankle fractures, including medial malleolus fractures and deltoid ligament injury.Methods: Between January 2012 and June 2014, patients with medial structure injuries were enrolled in this study and assigned to the medial malleolus fracture group or the deltoid ligament group. The surgical procedures for the two groups were documented. The follow-up endpoint was the time point when the steel plate or screw was removed from the lateral ankle. The Olerud-Molander ankle scoring system was used to assess ankle function.Results: A total of 84 patients with supination-external rotation type IV ankle fractures had complete medical records and were included in this study. The average age of the patients was 44.16 years (range, 15-75). The patient sample included 39 males and 45 females. Overall, 49 patients (19 males and 30 females) suffered a medial malleolus fracture. The average age of these patients was 40.20 years (range, 15-75). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 81.6% (40 patients) of these patients. Overall, 35 patients (20 males and 15 females) experienced a deltoid ligament injury. The average age of these patients was 44.21 years (range, 17-73). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 11.5% (four patients) of these patients. Open reduction was performed in patients with medial malleolus fractures, and two 4.0-mm cannulated screws were used to fixate the posterior malleolus and the medial malleolus. The sutureanchor technique was used to repair the ligaments in patients with deltoid ligament injuries. The follow-up endpoint was the time point when the steel plate and screws were removed from the lateral ankle in patients. The average follow-up period was 13.4 months (range, 11-17). The Olerud-Molander ankle scoring system was used to assess postoperative ankle function. The average score for the patients in the medial malleolus fracture group was 90.3 points (range, 85-95). The average score for the patients in the deltoid ligament injury group was 87.7 points (range, 80-95). No significant differences were found in the scores between the two groups. Conclusion:Medial malleolus fracture and deltoid ligament injury are two different presentations of supinationexternal rotation type IV ankle fractures. Anatomic reduction of the articular surface concurrent with restoration of ankle stability can achieve favorable results for these two injuries.

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“…Operative Wxation of the Wbular fracture is usually required in SER IV ankle fractures [4,13,19,21,37,52,54,58]. In the case of a medial malleolar fracture associated with deltoid ligament injury, Wxation of the medial malleolus may not restore ankle joint stability and an internal Wxation of Wbular fracture may be necessary [6,48,49,52]. Evaluation of the integrity of the deep deltoid ligament is particularly important when patients present with an isolated not dislocated Wbular fracture and a radiographically normal medial clear space [12].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

Bekerom

Mutsaerts

Dijk

2008

Arch Orthop Trauma Surg

113

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Background and purpose Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures. Methods The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to identify all published original studies concerning diagnostic modalities to evaluate the integrity of the deltoid ligament in adult ankle fractures. Results This review included nine studies involving 423 ankle fractures. Three trails investigated medial tenderness; two studies, ecchymosis; two studies, swelling; one study, an injury radiograph; six studies, a type of radiographic stress view; one study, the Lauge-Hansen classiWcation; one study, MRI; and one article studied arthroscopy in the evaluation of the deltoid ligament integrity. Interpretation Swelling, ecchymosis, medial tenderness, initial injury radiographs and the Lauge-Hansen classiWcation are less adequate predictors of the integrity of the deltoid ligament. Manual or the less painful variant, the gravity external rotation stress radiographs are considered the gold standard. The amount of medial clear space widening indicative of a positive external rotation stress test has been somewhat variable in the literature but ¸5 mm is generally regarded as most reliable. Achieving adequate external rotation of the foot when obtaining stress radiographs is more important than positioning the ankle in the appropriate degree of ankle Xexion. The amount of applied force necessary when performing an external rotation stress radiograph is not well deWned and mainly determined by the patient's pain level. The indication for surgery should not be based on the absolute value of one parameter but on the combination of several parameters. If nonoperative treatment is chosen despite a positive stress radiograph, close follow-up is critical because subluxation of the ankle joint is still possible. MRI could be useful in individual cases.

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Mechanical considerations for the syndesmosis screw. A cadaver study.

Cited by 235 publications

References 25 publications

Ankle Syndesmosis Injuries: Anatomy, Biomechanics, Mechanism of Injury, and Clinical Guidelines for Diagnosis and Intervention

Ankle Syndesmosis Injuries: Anatomy, Biomechanics, Mechanism of Injury, and Clinical Guidelines for Diagnosis and Intervention

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination‐External Rotation Type IV Ankle Fractures

Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

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