Technical Considerations in the Treatment of Syndesmotic Injuries Associated With Ankle Fractures

Gardner, Michael J.; Graves, Matthew; Higgins, Thomas F.; Nork, Sean E.

doi:10.5435/jaaos-d-14-00233

Cited by 31 publications

(33 citation statements)

References 44 publications

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“…Syndesmotic screws were placed when positive results were observed in the external rotation stress test (increased medial clear space at the ankle mortise) or in the Cotton test (>2 mm of lateral migration of the lateral malleolus) [15, 16]. …”

Section: Methodsmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe optimal method for the reduction and fixation of posterior malleolar fracture (PMF) remains inconclusive. Currently, both of the indirect and direct reduction techniques are widely used. We aimed to compare the reduction quality and clinical outcome of posterior malleolar fracture managed with the direct reduction technique through posterolateral approach or the indirect reduction technique using ligamentotaxis.MethodsPatients with a PMF involving over 25% of the articular surface were recruited and assigned to the direct reduction (DR) group or the indirect reduction (IR) group. Following reduction and fixation of the fracture, the quality of fracture reduction was evaluated in post-operative CT images. Clinical and radiological follow-ups were performed at 6 weeks, 3 months, 6 months, 12 months, and then at 6 month-intervals postoperatively. Functional outcome (AOFAS score), ankle range of motion, and Visual Analog Scale (VAS) were evaluated at the last follow-up. Statistical differences were compared between the DR and IR groups considering the patient demographics, quality of fracture reduction, AOFAS score, and VAS.ResultsTotally 116 patients were included, wherein 64 cases were assigned to the DR group and 52 cases were assigned to the IR group. The quality of fracture reduction was significant higher in the DR group (P = 0.038). In the patients who completed a minimum of 12 months’ follow-up, a median AOFAS score of 87 was recorded in the DR group, which was significantly higher than that recorded in the IR group (a median score of 80). The ankle range of motion was slightly better in the DR group, with the mean dorsiflexion restriction recorded to be 5.2° and 6.1° in the DR and IR group respectively (P = 0.331). Similar VAS score was observed in the two groups (P = 0.419).ConclusionsThe direct reduction technique through a posterolateral approach provide better quality of fracture reduction and functional outcome in the management of PMF over 25% of articular surface, as compared with the indirect reduction technique using ligamentotaxis.Trial registration NCT02801474 (retrospectively registered, June 2016, ClinicalTrails.gov).

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Section: Methodsmentioning

confidence: 99%

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Xiong

Chen

et al. 2017

BMC Musculoskelet Disord

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“…Overcompression of the syndesmosis screw may affect ankle movements and consequently treatment results. [10,11] In the current study, the minimum value for overcompression was determined as 2.2 mm. The bilateral values regarding TFCS were found to be equal (p=1.0) to prevent overcompression.…”

Section: Discussionmentioning

confidence: 98%

“…However, anatomic reduction is necessary for successful outcomes, as even 1.5 mm malreduction may cause negative clinical outcomes. [3,9] Gardner et al [10] detected a malreduction rate reaching 50% in the postoperative CT evaluations. The amount of syndesmosis needed to be compressed for a reduced syndesmosis should be determined because overcompression of syndesmosis may affect the movement and functional outcomes of the ankle.…”

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confidence: 97%

The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: A regional study in Turkey

Yaradılmış

2020

Jt Dis Relat Surg

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This study aims to improve the diagnostic reliability of syndesmosis injuries through evaluation of radiological measurements in the Turkish population and to provide mean reference values to prevent malreduction and overcompression during the treatment. Patients and methods: This retrospective study was performed between January 2018 and May 2018. The bilateral anteroposterior (AP) and lateral radiographs of 100 patients (60 males, 40 females; mean age 42.9 years; range, 23 to 72 years) who presented at our polyclinic were analyzed. Tibiofibular overlap (TFO), tibiofibular clear space (TFCS) and medial clear space (MCS) measurements were performed on the AP radiographs. The lateral radiographs were evaluated in respect of the anterior tibiofibular interval (ATFI), posterior tibiofibular interval (PTFI), and anterior tibiofibular ratio (ATFR) for syndesmosis reduction assessment. The lower and upper limits, mean and median values of the measurements were recorded. Results: The measurements on the AP radiographs were determined to be as TFO: 7.9±2.4 mm (4-13), TFCS: 3.8±0.9 mm (2.2-6), MCS: 3.3±0.4 mm (2.7-4.5), and superior clear space: 3.3±0.3 mm (2.7-3.8). According to the measurements on the AP radiographs, the TFCS did not show any difference in terms of the variables of age, gender and side (p=0.070, p=0.219 and p=1.0, respectively). These measurements on the AP radiographs showed a high statistical consistency in terms of side (p=0.72, p=1.0, p=0.900 and p=0.920, respectively). The measurements on the lateral radiographs were as ATFI: 12.8±2.4 mm (8-18), PTFI: 6.1±2.9 mm (3-15) and ATFR: 0.4±0.1 (0.28-0.5). According to the measurements on the lateral radiographs, the ATFR did not show any difference in terms of the variables of age, gender and side (p=0.750, p=0.570 and p=0.848, respectively). The lateral measurements indicated statistical consistency in terms of side (p=0.400, p=0.260 and p=0.848, respectively). Conclusion: On the AP radiographs, TFCS was found to be reliable and the intraoperative evaluation of its high consistency with the opposite extremity is appropriate to avoid overcompression. The evaluation of ATFR on lateral radiographs was found to be reliable and evaluation is recommended to avoid intraoperative malreduction.

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“…Plates and screws used for ankle fracture fi xation do not routinely require removal with the exception of syndesmotic fi xation screws. The syndesmotic screws should be removed at approximately 4-6 months following initial surgery and should be removed prior to the player returning to competition [ 6 ].…”

Section: Ankle Fracturesmentioning

confidence: 99%

Foot and Ankle Injuries in the Young Tennis Athlete

Weinfeld

2016

Contemporary Pediatric and Adolescent Sports Medicine

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Foot and ankle injuries are quite common in tennis athletes. These include Achilles tendon injuries, ankle sprains and fractures, metatarsal fractures, midfoot sprains (Lisfranc), as well as forefoot injuries including turf toe. Plantar fasciitis and stress fractures also occur commonly in this population. Tennis participation places increased stresses on the foot and ankle due to the acute start and stop nature of the sport as well as sudden changes of direction. Foot and ankle injuries may be prevented by use of proper conditioning techniques, appropriate bracing and shoe wear, and stretching exercises before playing.

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Technical Considerations in the Treatment of Syndesmotic Injuries Associated With Ankle Fractures

Cited by 31 publications

References 44 publications

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures

The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: A regional study in Turkey

Foot and Ankle Injuries in the Young Tennis Athlete

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