Strategies to Avoid Syndesmosis Malreduction in Ankle Fractures

Stenquist, Derek S; Kwon, John Y.

doi:10.1016/j.fcl.2020.08.001

Cited by 8 publications

(5 citation statements)

References 115 publications

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“…Screw fixation is still the most popular stabilizing technique for syndesmotic injuries 10 ; the malreduction of the syndesmotic joint has been increasingly reported to be a significant problem, and the incidence was between 16% and 52%. 9,13,24 Based on radiographic parameters, Weening and Bhandari 26 found that the prevalence of malreduction of syndesmosis fixed with screws was 16% and noted that the only significant predictor of functional outcome was reduction of the syndesmosis. Based on postoperative CT scans, Gardner et al 9 reported a prevalence of malreduction of 52% based on CT scans, compared with only 24% based on standard radiographic criteria.…”

Section: Discussionmentioning

confidence: 99%

A Novel Flexible Fixation Method for Syndesmotic Injury

Dong

Wang

et al. 2023

Foot Ankle Int.

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Background: This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the “embrace” technique. Methods: Between March 2018 and October 2020, a total of 67 patients with ankle fractures and syndesmotic injuries underwent syndesmosis fixation with the embrace technique at our institute. Plain radiographs and computed tomographic (CT) scans were obtained preoperatively. Postoperative radiographic assessment included anteroposterior (AP) and lateral radiographs and CT scans of both ankles. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Olerud-Molander Ankle Score, and visual analog scale (VAS) score were used for postoperative assessment. Results: The mean age was 27.6 ± 10.9 (range, 14-56) years. The mean follow-up time was 30.3 ± 6.2 (range, 24-48) months. There were no malreductions indicated by any CT parameter except fibular rotation in a postoperative comparison between 2 sides. We found significant preoperative-postoperative changes in anterior difference, posterior difference, and fibular rotation but no significant preoperative-postoperative difference in fibular translation. There was no significant postoperative difference between the affected-side and normal-side measurements of any parameter. Complications included delayed wound healing, lateral pain because of wire knot irritation (11.9%), and medial fiber wire irritation (7.5%). The mean AOFAS, Olerud-Molander, and VAS scores at the last follow-up were 94.4 ± 6.8 (range, 84-100), 95.4 ± 6.1 (range, 80-100), and 0.68 ± 1.0 (range, 0-3) points, respectively. Conclusion: In our cohort, this novel technique proved to be an effective method for syndesmosis fixation in patients with ankle fractures associated with very good radiologic and patient-reported outcomes. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 99%

A Novel Flexible Fixation Method for Syndesmotic Injury

Dong

Wang

et al. 2023

Foot Ankle Int.

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“…Malreduction of both the fibula and the distal tibiofibular syndesmosis after surgical management of ankle fractures has been recognized as a factor of poor prognosis and premature articular degeneration. 30 , 35 , 37 , 40 Therefore, assessment of the restoration of anatomical parameters by means of plain radiography and CT scan evaluation has been widely studied but mostly on patients treated with plate osteosynthesis. 1 , 11 , 19 , 25 Limitations of both standard fluoroscopy and radiographs in detecting malreduction of the syndesmosis have made CT scanning the standard for postoperative evaluation of fibular malreduction.…”

Section: Discussionmentioning

confidence: 99%

Restoration of Anatomic Parameters and Syndesmotic Reduction After Intramedullary Nailing of Distal Fibular Fractures

Bastías

Bravo²,

Astudillo

et al. 2022

Foot & Ankle Orthopaedics

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Background: Intramedullary nailing of the fibula (FN) is a method of fixation that has proven to be useful for treating distal fibular fractures (DFs). FN minimizes soft tissue complications and provides similar stability to plating, with fewer hardware-related symptoms. Nevertheless, FN has been associated with syndesmotic malreduction and the incapacity of restoring length and rotation of the fibula. We aimed to evaluate the fibular position and syndesmotic reduction after fixation with FN compared with the uninjured ankle in the immediate postoperative period. Methods: Prospective cohort study. Patients with DF fractures treated with IN between January 2017 and January 2020 were included. Immediate postoperative bilateral ankle CT was obtained in all cases. Fibular rotation, length, and translation as well as syndesmotic diastasis were measured on both ankles and compared by 3 independent observers. Results: Twenty-eight patients were included (16 women). The mean age was 46 years (range 16-91). Fracture type distribution according to AO/ASIF classification included 19 patients with 44.B (67.9%), 8 patients with 44.C (28.6%), and 1 patient with a 44.A fracture (3.6%). No significant differences were identified considering fibular rotation ( P = .661), syndesmotic diastasis ( P = .147), and fibular length ( P = .115) between the injured and uninjured ankle. Fibular translation had statistical differences ( P = .01) compared with the uninjured ankle. The intraclass correlation coefficient showed an excellent concordance between observers except for fibular translation on the injured ankle. Conclusion: In this cohort, fixation of DF fractures with FN allows restoration of anatomical parameters of the ankle in terms of fibular rotation, length, and syndesmotic diastasis. However, fibular translation had significant differences compared with the uninjured ankle based on bilateral CT scan evaluation. Level of Evidence: Level II, prospective cohort study.

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“…106,107,110,[191][192][193][194] Achieving accurate syndesmotic reduction and its maintenance is considered a critical factor in the treatment of ankle fractures with associated syndesmotic instability. 195 Rates of syndesmotic malreduction are higher in Weber C fibular fractures than in Weber B fibular fractures. 118,196 Rates of syndesmotic malreduction are almost double in pronation external rotation injuries than in supination external injuries.…”

Section: Syndesmotic Injuries With Ankle Fracturesmentioning

confidence: 97%

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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Strategies to Avoid Syndesmosis Malreduction in Ankle Fractures

Cited by 8 publications

References 115 publications

A Novel Flexible Fixation Method for Syndesmotic Injury

A Novel Flexible Fixation Method for Syndesmotic Injury

Restoration of Anatomic Parameters and Syndesmotic Reduction After Intramedullary Nailing of Distal Fibular Fractures

Instability of the distal tibiofibular syndesmosis

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