Reliability of the “Clinical Tibiofibular Line” Technique for Open Syndesmosis Reduction Assessment

Pollizzi, Anthony; Herman, Daniel C.; Berlet, Gregory C.; Reb, Christopher W.

doi:10.1177/1938640020948667

Cited by 2 publications

(1 citation statement)

References 18 publications

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“…126 The "tibiofibular line" (TFL) is a CT-based technique found to be sensitive to malreduction and in one recent study, it was shown that CT based TFL can be effectively translated into a reliable open technique. 127 The accuracy of the achieved reduction should be verified by comparing it with perfect mortise and lateral view of the opposite uninjured side, which is used as a template in the operating room. 128 Arthroscopy is another method used to identify instability as well as verify reduction.…”

Section: Operative Treatmentmentioning

confidence: 99%

Instability of the distal tibiofibular syndesmosis

Vohra¹,

Singh²,

Thorat³

et al. 2023

J Orthop Surg (Hong Kong)

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The distal tibiofibular syndesmosis (DTFS) is more frequently injured than previously thought. Early diagnosis and appropriate treatment is essential to avoid long term complications like chronic instability, early osteoarthritis and residual pain. Management of these injuries require a complete understanding of the anatomy of DTFS, and the role played by the ligaments stabilizing the DTFS and ankle. High index of suspicion, appreciating the areas of focal tenderness and utilizing the provocative maneuvers help in early diagnosis. In pure ligamentous injuries radiographs with stress of weight bearing help to detect subtle instability. If these images are inconclusive, then further imaging with MRI, CT scan, stress examination under anesthesia, and arthroscopic examination facilitate diagnosis. An injury to syndesmosis frequently accompanies rotational fractures and all ankle fractures need to be stressed intra-operatively under fluoroscopy after fixation of the osseous components to detect syndesmotic instability. Non-operative treatment is appropriate for stable injuries. Unstable injuries should be treated operatively. Anatomic reduction of the syndesmosis is critical, and currently both trans-syndesmotic screws and suture button fixation are commonly used for syndesmotic stabilization. Chronic syndesmotic instability (CSI) requires debridement of syndesmosis, restoration of ankle mortise with or without syndesmotic stabilization. Arthrodesis of ankle is used a last resort in the presence of significant ankle arthritis. This article reviews anatomy and biomechanics of the syndesmosis, the mechanism of pure ligamentous injury and injury associated with ankle fractures, clinical, radiological and arthroscopic diagnosis and surgical treatment.

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Section: Operative Treatmentmentioning

confidence: 99%

Instability of the distal tibiofibular syndesmosis

Vohra¹,

Singh²,

Thorat³

et al. 2023

J Orthop Surg (Hong Kong)

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A 3-Ligament Syndesmotic Injury Is at Higher Risk for Malreduction Than a 2-Ligament Injury: A CT-Based Analysis

Spindler,

Böcker,

Polzer

et al. 2024

Foot Ankle Int.

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Background: Syndesmotic malreduction is common and has been associated to an impaired outcome. Various risk factors for DTFJ malreduction have been postulated. The aims of this study were to assess the DTFJ malreduction rate based on (1) the severity of the syndesmotic injury, (2) the anatomy of the tibial incisura, and (3) the fixation device used in patients treated with suture-button systems. Methods: This retrospective, radiographic study included all adult patients who were treated for an acute, unilateral, and unstable syndesmotic injury with a suture-button system and postoperative bilateral CT imaging. Included were isolated syndesmotic injuries and fracture cases. The number of syndesmotic ligaments injured, that is, 2-ligament (AiTFL+IOL) and 3-ligament (AiTFL+IOL+PiTFL), was rated for each patient. The quality of DTFJ reduction, as well as the anatomy of the tibial incisura, was rated based on the postoperative, bilateral CT images and the intraoperative DTFJ reduction was recalculated based on the drilling-tunnel deviation. The possible influence on the DTFJ malreduction rate was assessed. Results: A total of 147 patients were included, and 94 and 53 patients had a 2- and 3-ligament syndesmotic injury, respectively. In addition, 113 patients were treated with a single-button system, 26 with a double suture-button system, and 8 with a hybrid fixation (suture-button + screw). Malreduction was significantly higher in 3-ligament compared with 2-ligament injuries, both intraoperatively (51% vs 27%; P = .003) and postoperatively (28% vs 11%; P = .006). The tibial anatomy had no significant influence on the malreduction rates. No significant differences were seen per the different fixation devices used independent of the number of ligaments injured. Conclusion: This study did not find an influence of the incisura’s anatomy on the DTFJ malreduction rate. However, we did find that 3-ligament syndesmotic injuries carried a higher risk of intra- and postoperative malreduction compared with 2-ligament injuries. Level of Evidence: Level III, retrospective radiologic study.

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Reliability of the “Clinical Tibiofibular Line” Technique for Open Syndesmosis Reduction Assessment

Cited by 2 publications

References 18 publications

Instability of the distal tibiofibular syndesmosis

Instability of the distal tibiofibular syndesmosis

A 3-Ligament Syndesmotic Injury Is at Higher Risk for Malreduction Than a 2-Ligament Injury: A CT-Based Analysis

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