Ankle Syndesmotic Fixation Using Two Screws: Risk of Injury to the Perforating Branch of the Peroneal Artery

Penera, Keith; Manji, Karim; Wedel, Mathew; Shofler, David; Labovitz, Jonathan M.

doi:10.1053/j.jfas.2014.04.006

Cited by 17 publications

(15 citation statements)

References 20 publications

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“…The vascularity of syndesmosis has been enthusiastically studied. The perforating branch of peroneal artery mainly supplies the surrounding ligaments [24,32]. In advanced PE injuries, the interosseous membrane tears from the upper edge of the syndesmosis upwards to the fractured bula [6,13,14,26,33].…”

Section: Discussionmentioning

confidence: 99%

Should the Diastatic Syndesmosis be Stabilized in Advanced Pronation-External Rotation Ankle Injuries? A Retrospective Cohort Comparison

Wu¹,

Yeh²,

Lee³

et al. 2020

Preprint

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Background: Ankle injuries with the advanced pronation-external rotation (PE) type are relatively uncommon and the debate about whether the diastatic syndesmosis should be stabilized concomitantly has yet achieved a consensus. Comparison of using (Group 1) or non-using (Group 2) screw stabilization for the diastatic syndesmosis was performed retrospectively. Methods: With the 10-year period, 81 consecutive adult patients with advanced PE ankle injuries (stage 3 or 4 PE type) were treated. After malleolar fractures were internally stabilized with screws and plates, the syndesmotic stability was re-checked by external rotation and hook tests. The necessity of insertion of cortical screws to stabilize diastatic syndesmosis was decided by the individual orthopedic surgeon. The outcomes of both approaches were compared. Results: Seventy-one patients were followed for at least one year (87.7%; average, 2 years; range, 1-11 years). Group 1 had 22 patients and Group 2, 49 patients. The union rate in Group 1 was 100% (22 / 22) and in Group 2, 91.8% (45 / 49; p= 0.30). Syndesmosis re-diastasis occurred in 13.6% (3 / 22) of Group 1 and 30.6% (15 / 49) of Group 2 (p= 0.13). Satisfactory ankle function was noted in 86.4% (19 / 22) of Group 1 and 65.3% (32 / 49) of Group 2 (p= 0.07). Conclusion: Although clinical comparison cannot demonstrate statistical difference, screw stabilization of the diastatic syndesmosis may guarantee safer results. The statistical insignificance may be due to insufficient sample sizes. Clinically and theoretically, insertion of syndesmotic screws to promote ligament healing may be reasonable.

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Section: Discussionmentioning

confidence: 99%

Should the Diastatic Syndesmosis be Stabilized in Advanced Pronation-External Rotation Ankle Injuries? A Retrospective Cohort Comparison

Wu¹,

Yeh²,

Lee³

et al. 2020

Preprint

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show abstract

“…Xenos et al (1995) reported that two screws instead of one would provide more stability in the treatment of syndesmosis injuries [30]. However, Penera et al (2014) reported in a cadaver study that when two syndesmosis screws are inserted, there could be a high risk of the proximal screw to injure the perforators of the peroneal artery [31]. Stuart and Panchbhavi (2011) determined that suprasyndesmotic and transsyndesmotic screw insertions led to similar clinical and radiological results [32].…”

Section: Discussionmentioning

confidence: 99%

Determination of The Most Appropriate Surgical Treatment in Syn-desmotic Injury of Ankle Joint: Application of Taguchi Method

Uğur

2017

mech

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“…While numerous surgeons have recognized the importance of the anatomic stabilization of the distal tibiofibular syndesmosis, the proportions of syndesmotic malreductions range from 16 percent to 52 percent [2,[10][11][12]. Previous data indicate that an eccentric clamp or screw trajectory may lead to syndesmotic malreduction [13,14]. Ideally, the reductional clamp and screw would be placed in line with the trans-syndesmotic angle to avoid malreduction [16].…”

Section: Introductionmentioning

confidence: 99%

Kirschner Wire as a Reference Marker for the Positioning of a Syndesmotic Screw: a Radiological Study and Clinical Application

Zhang¹,

Wang²,

Duan³

et al. 2021

Preprint

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Background: Without a reliable and static reference, the rate of eccentrically positioned distal syndesmotic screw is very high. This article describes an additional method to improve surgeons’ ability to ideally place this screw. The purposes of our study were (1) to determine if an ideal space at 2.5 cm proximal to the plafond existed between the tibia and fibula for the placement of a Kirschner (K) wire and (2) to detect if it could act as a reliable and static fibular incisura plane reference. Methods: Computed tomography (CT) scans of 42 uninjured adult ankles with foot fractures were analysed to measure the tibiofibular vertical distance (TFVD) at 2.5 cm proximal to the plafond on transverse images. TFVD was defined as the distance between two lines: Line 1 was tangent to the fibular incisura, and Line 2 was parallel to Line 1 along the medial fibula. Patients were divided into four groups according to our TFVD data: 0–1, 1–2, 2–3, and 3–4 mm, and the number of patients in each group was counted. We assessed 23 patients who underwent syndesmotic screw fixation for ankle fractures. Comparison of the angle between the anatomic axis of the syndesmosis and screw axis (AAS) was performed between patients using conventional method (11 patients) and with K-wire marker (12 patients). Results: TFVD measured 2.23 ± 1.01 mm at 2.5 cm proximal to the plafond. TFVD occurred at 25% of the distance from 2 to 3 mm in 47.6% of patients. This new technique decreased the deformation of AAS by 75%, from 13.06 ± 2.55° to 4.28 ± 1.72°, in the conventional group.Conclusions: Placing a 1.6-mm K-wire in the syndesmosis at 2.5 cm proximal to the tibial plafond is easy because of emerging TFVDs. Compared to the conventional method, this new technique increased the accuracy of syndesmotic screw placement by up to 75 percent. Therefore, K-wire could be used as a reliable and static intraoperative reference of the fibular incisura plane through which surgeons can accurately place a screw trajectory.

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Ankle Syndesmotic Fixation Using Two Screws: Risk of Injury to the Perforating Branch of the Peroneal Artery

Cited by 17 publications

References 20 publications

Should the Diastatic Syndesmosis be Stabilized in Advanced Pronation-External Rotation Ankle Injuries? A Retrospective Cohort Comparison

Should the Diastatic Syndesmosis be Stabilized in Advanced Pronation-External Rotation Ankle Injuries? A Retrospective Cohort Comparison

Determination of The Most Appropriate Surgical Treatment in Syn-desmotic Injury of Ankle Joint: Application of Taguchi Method

Kirschner Wire as a Reference Marker for the Positioning of a Syndesmotic Screw: a Radiological Study and Clinical Application

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