Validation of a new method for evaluation of syndesmotic injuries of the ankle

Ahrberg, Annette B.; Hennings, Robert; Dercks, Nikolaus von; Hepp, Pierre; Josten, Christoph; Spiegl, Ulrich

doi:10.1007/s00264-020-04631-9

Cited by 8 publications

(11 citation statements)

References 25 publications

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“…Because of interindividual anatomic differences in syndesmotic width and morphologic variants, bilateral CT control is superior to conventional radiography [10,11,13,28,35,37]. This has shown rates of syndesmotic malreduction between 0 and 42%, with various definitions [5,10,14,14].…”

Section: Discussionmentioning

confidence: 99%

“…Pitch was 0.329 with a rotation time of 0.5 s. Multiplanar reformations were reconstructed in slice thickness of 0.67-2 mm in axial, sagittal and coronal orientation. Syndesmotic reduction was assessed 10 mm proximal of the ankle joint using validated landmark-based techniques according to Schon et al [27,28]. Measurements were made using SieNet MagicWeb (Siemens AG, Medical Solutions, Germany) by one experienced orthopedic and trauma surgeon who was trained in the measurement methods.…”

Section: Ct Scan Image Analysismentioning

confidence: 99%

“…The anterior-posterior translation was assessed to define the anterior tibiofibular distance according to Ahrberg et al(antTFD; Fig. 1c) [28]. These parameters were selected due to their high intra-observer and interobserver reliability in evaluating side differences as demonstrated in the literature and were assessed for both sides [27,28].…”

Section: Ct Scan Image Analysismentioning

confidence: 99%

“…1c) [28]. These parameters were selected due to their high intra-observer and interobserver reliability in evaluating side differences as demonstrated in the literature and were assessed for both sides [27,28]. The side-to-side differences between injured and uninjured sides were calculated and defined as ΔLCS, ΔNTDA and ΔantTFD.…”

Section: Ct Scan Image Analysismentioning

confidence: 99%

“…Fig.1Transversal plane of computer tomography 10 mm above the ankle joint demonstrate the measurement of Leporjärvi Clear Space (LCS; 2a), Nault talar dome angle (NTDA; 2b) and anterior tibiofibular distance (antTFD; 2c) at the injured ankle joint[28][29][30] …”

mentioning

confidence: 99%

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Does the orientation of syndesmosis fixative device affect the immediate reduction of the distal tibiofibular joint?

Hennings¹,

Spiegl²,

Fuchs³

et al. 2021

Arch Orthop Trauma Surg

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Introduction Incongruent stabilization of the distal tibiofibular joint (syndesmosis) results in poorer long-term outcome in malleolar fractures. The aim was to analyze whether the orientation of the syndesmotic stabilization would affect the immediate reduction imaged in computed tomography (CT). Materials and methods The syndesmotic congruity in 114 ankle fractures with stabilization of the syndesmosis were retrospectively analyzed in the post-operative bilateral CT scans. The incisura device angle (IDA) was defined and correlated with the side-to-side difference of Leporjärvi clear-space (ΔLCS), anterior tibiofibular distance (ΔantTFD) and Nault talar dome angle (ΔNTDA) regardless of the stabilization technique and separately for suture button system and syndesmotic screw. Asymmetric reduction was defined as ΔLCS > 2 mm and |ΔantTFD|> 2 mm. Results Regardless of the stabilization technique, no correlation between the IDA and the ΔLCS (r = 0.069), the ΔantTFD (r = 0.019) nor the ΔNTDA (r = 0.177) could be observed. There were no differences between suture button system and syndesmotic screw. Asymmetrical reduction was detected in 46% of the cases, while sagittal asymmetry was most common. No association was found between the orientation of stabilization device and occurrence of asymmetrical reduction (p > 0.05). The results of suture button system and syndesmotic screw were comparable in this respect (p > 0.05). Conclusion Poor correlation between the orientation of the stabilization device and the immediate post-operative congruity of the syndesmosis could be shown. In contrast to current literature, this study did not show difference of suture button system over syndesmotic screw in this regard. Careful adjustment of the fibula in anteroposterior orientation should be given special attention.

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Section: Discussionmentioning

confidence: 99%

Section: Ct Scan Image Analysismentioning

confidence: 99%

Section: Ct Scan Image Analysismentioning

confidence: 99%

Section: Ct Scan Image Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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Does the orientation of syndesmosis fixative device affect the immediate reduction of the distal tibiofibular joint?

Hennings¹,

Spiegl²,

Fuchs³

et al. 2021

Arch Orthop Trauma Surg

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Syndesmotic Injuries

Lintz

Fernando

Bernasconi

et al. 2022

Tendon and Ligament Injuries of the Foot and Ankle

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“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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Validation of a new method for evaluation of syndesmotic injuries of the ankle

Cited by 8 publications

References 25 publications

Does the orientation of syndesmosis fixative device affect the immediate reduction of the distal tibiofibular joint?

Does the orientation of syndesmosis fixative device affect the immediate reduction of the distal tibiofibular joint?

Syndesmotic Injuries

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

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