Syndesmotic malreduction may decrease fixation stability: a biomechanical study

Bai, Lu; Zhang, Wentao; Guan, Siyao; Liu, Jianxin; Chen, Peng

doi:10.1186/s13018-020-01584-y

Cited by 12 publications

(4 citation statements)

References 24 publications

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“…The most important ligamentous complex in the ankle is the syndesmosis [ 20 ]. Instability, discomfort and arthrosis can result from disturbance [ 21 ]. Malreduced syndesmotic injuries have been associated with inferior functional results as measured by the Olerud/Molander questionnaire, which is specific to the ankle, and the short-form musculoskeletal assessment, which evaluates general health [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Different Methods to Evaluate Ankle Syndesmosis on Lateral Ankle Radiographs

Elsenosy,

Mansy,

Hassan

et al. 2023

Cureus

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BackgroundAnkle sprains and fractures rank among the most commonly occurring musculoskeletal injuries and hold significant relevance in current medical practice. Accurate information regarding these injuries is crucial for their effective treatment. This study aimed to explore the viability of utilizing ankle lateral radiographs to evaluate syndesmosis in both emergency settings and operating theatres. MethodsThis randomized retrospective clinical study involved the analysis of 150 ankle lateral radiographs (54 males and 96 females) from patients who presented at our emergency department with suspected ankle injuries. Two authors jointly examined these radiographs and reached a consensus. The anterior tibiofibular (ATF) ratio and anterior-posterior tibiofibular (APTF) ratio were computed. Patients requiring syndesmotic fixation were classified as having experienced a genuine syndesmotic injury. Participants were randomly divided into two equal groups: Group I (normal group) without fractures and Group II (abnormal group) with fractures. Comprehensive patient data, including medical history and clinical examinations, were recorded. ResultsGender distribution within the studied population consisted of 54.67% males (n=41) and 45.33% females (n=34) in the abnormal group, while the normal group comprised 37.33% males (n=28) and 62.67% females (n=47). Both APTFR and ATFR methods were found to be inconclusive and unreliable for syndesmosis assessment in ankles. The sensitivity of APTFR stood at 21.33%, with a specificity of 86.67%, a positive predictive value (PPV) of 61.5%, and a negative predictive value (NPV) of 52.4%. Meanwhile, the sensitivity of ATFR was 32%, with a specificity of 80%, a PPV of 61.5%, and an NPV of 54.1%. ConclusionsBoth techniques demonstrated low sensitivity when ankle fractures were present, indicating their unsuitability for routine clinical diagnosis of syndesmotic disruption via lateral ankle radiographs.

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Section: Discussionmentioning

confidence: 99%

Comparison of Two Different Methods to Evaluate Ankle Syndesmosis on Lateral Ankle Radiographs

Elsenosy,

Mansy,

Hassan

et al. 2023

Cureus

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“…The single most important prognostic factor after unstable injury of the distal tibiofibular syndesmosis with or without fracture is anatomic reduction of the distal fibula and fitting into the tibial incisura [112]. Therefore, anatomic reduction of an injured syndesmosis is crucial for an optimal long-term clinical result [7,13,31,151]. In this context, anatomic reduction is defined as complete restoration of the physiological anatomy in the first place but does also imply recovery of the physiologic tension of the repaired ligamentous structures.…”

Section: Importance Of Anatomic Reductionmentioning

confidence: 99%

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Regauer¹,

Mackay

Nelson

et al. 2022

JCM

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Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

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“…Studies have shown that the fibula moves three-dimensionally in response to foot rotation [ 14 , 24 – 26 ]. In the case of deliberate syndesmotic malreduction in a cadaver model, suture button fixation resulted in less post-fixation displacement than SYS fixation [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

“Flexible nature of fixation” in syndesmotic stabilization of the inferior tibiofibular joint affects the radiological reduction outcome

Hennings¹,

Fuchs²,

Spiegl³

et al. 2022

International Orthopaedics (SICOT)

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Purpose Fibular mobility after suture button stabilization (SBS) of inferior tibiofibular joint (syndesmosis) injuries has been described. This effect is called the “flexible nature of fixation (FNF).” In this study, we aimed to quantify FNF in syndesmotic stabilization. Methods Postoperative bilateral computed tomography (CT) of ankle fractures with syndesmosis stabilization by SBS or syndesmotic screw (SYS) was retrospectively analyzed. The transverse offset (TO) and vertical offset (VO) were defined by evaluating the drill channels. The reduction outcome was evaluated by the side-to-side difference between the clear space and the anterior tibiofibular distance (antTFD). The calculated anterior tibiofibular distance (cal-antTFD) was calculated by subtracting the TO from the validated antTFD. Subsequently, a reevaluation of the reduction outcomes after SYS or SBS stabilization was performed using cal-antTFD. Results Sixty patients (44 with SBS and 16 with SYS stabilization) were analyzed. The intra-rater and inter-rater reliabilities for TO and VO were excellent (α > 0.92). SYS stabilization showed lower mean TO (− 0.02 mm; SD 0.14) and VO (0.11 mm; SD, 0.29 mm) than SBS stabilization (TO 1.16 mm, SD 1.4 mm; VO 0.2 mm, SD 0.8 mm; p = 0.001). The rate of malreduction according to cal-antTFD was higher than that of antFTD (p = 0.033). Conclusion The presented method, which evaluates the position of the tibial to the fibular drill channel, allowed the quantification of the “FNF.” The often described difference in the dynamic stabilization of SBS compared to the rigid stabilization by SYS could be objectified. Considering cal-antTFD illustrates that FNF potentially reduces the rate of malreduction in SBS stabilization.

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Syndesmotic malreduction may decrease fixation stability: a biomechanical study

Cited by 12 publications

References 24 publications

Comparison of Two Different Methods to Evaluate Ankle Syndesmosis on Lateral Ankle Radiographs

Comparison of Two Different Methods to Evaluate Ankle Syndesmosis on Lateral Ankle Radiographs

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

“Flexible nature of fixation” in syndesmotic stabilization of the inferior tibiofibular joint affects the radiological reduction outcome

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