Factors associated with adverse events after distal tibiofibular syndesmosis fixation

Lemmers, Daniel H.L.; Lubberts, Bart; Stavenuiter, Ruben; Guss, Daniel; Johnson, Anne H.; Kerkhoffs, Gino M. M. J.; DiGiovanni, Christopher W.

doi:10.1016/j.injury.2019.12.011

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…Iatrogenic injury to the peroneal artery due to the syndesmosis screw for syndesmotic fixation may cause lower extremity compartment syndrome [ 11 ]. Although the certain benefit of surgical fixation in syndesmosis injury is known, adverse effects can be seen after syndesmosis fixation and the certain reasons are unclear [ 24 ]. At the same time, the reason for prolonged recovery time after syndesmotic ligament injury is unclear [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography

Aytekin,

Çakır,

Taşdemir

et al. 2024

Arch Orthop Trauma Surg

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Introduction The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. Materials and methods The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. Results The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5 mm exhibited the least potential for peroneal artery injury. Conclusion Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5 cm proximal to the ankle joint using a 3.5 mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1 cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.

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Section: Discussionmentioning

confidence: 99%

Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography

Aytekin,

Çakır,

Taşdemir

et al. 2024

Arch Orthop Trauma Surg

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“…Iatrogenic damage to this joint may explain some of the poor outcomes seen after syndesmotic fixation. 16,23,27,31 Several articles have described the tibiofibular contact zone at the base of the syndesmosis, and identify this articulation as a distinct synovial-lined joint with articular cartilage. 1,4,5,9,10,17,28,35,36 The syndesmotic recess is a synovial-lined plica that extends from the tibiotalar joint proximally to the distal insertional fibers of the interosseous tibiofibular ligaments.…”

Section: Discussionmentioning

confidence: 99%

Articular Cartilage of the Syndesmosis: Avoiding Iatrogenic Cartilage Injury During Syndesmotic Fixation

et al. 2021

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Background: The optimal surgical management of syndesmosis injuries consists of internal fixation between the distal fibula and tibia. Much of the available data on this joint details the anatomy of the syndesmotic ligaments. Little is published evaluating the distribution of articular cartilage of the syndesmosis, which is of importance to minimize the risk of iatrogenic damage during surgical treatment. The purpose of this study is to describe the articular cartilage of the syndesmosis. Methods: Twenty cadaveric ankles were dissected to identify the cartilage of the syndesmosis. Digital images of the articular cartilage were taken and measured using calibrated digital imaging software. Results: On the tibial side, distinct articular cartilage extending above the plafond was identified in 19/20 (95%) specimens. The tibial cartilage extended a mean of 6 ± 3 (range, 2-13) mm above the plafond. On the fibular side, 6/20 (30%) specimens demonstrated cartilage proximal to the talar facet, which extended a mean of 24 ± 4 (range, 20-31) mm above the tip of the fibula. The superior extent of the syndesmotic recess was a mean of 10 ± 3 (range, 5-17) mm in height. In all specimens, the syndesmosis cartilage did not extend more than 13 mm proximal to the tibial plafond and the syndesmotic recess did not extend more than 17 mm proximal to the tibial plafond. Conclusion: Syndesmosis fixation placed more than 13 mm proximal to the tibial plafond would have safely avoided the articular cartilage in all specimens and the synovial-lined syndesmotic recess in most. Clinical Relevance: This study details the articular anatomy of the distal tibiofibular joint and provides measurements that can guide implant placement during syndesmotic fixation to minimize the risk of iatrogenic cartilage damage.

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“…However, an osteoporosis evaluation is not necessarily required after an ankle fracture as it does not appear that osteoporosis is a significant risk factor for ankle fractures [ 13 ]. There are limited studies exploring the strength of suture buttons in osteoporotic bone in the ankle; a literature search returned only one study that showed osteoporosis was a factor in the development of infection within one year after SB fixation [ 14 ]. While the direct comparison of SB and syndesmotic screws has been widely evaluated, few studies have compared SB construct outcomes among patients of different age groups.…”

Section: Introductionmentioning

confidence: 99%

Transosseous Fixation of the Distal Tibiofibular Syndesmosis: Comparison of Interosseous Suture and Endobutton Across Age Groups

Baxter¹,

Farris²,

Johnson³

et al. 2023

Cureus

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BackgroundIn the ankle, suture bridge fixation for syndesmotic injuries is commonly employed. Initial recommendations for suture bridge constructs advised against using the device in patients with insufficient quantity or quality of bone. Therefore, many surgeons limit its use to younger, more athletic patients and use traditional screw fixation in older, less active patients. The purpose of this study is to compare the outcomes of suture bridge fixation for syndesmotic repair in patients ≥ 60 years old vs patients < 60 years old. MethodsA retrospective review of 140 ankle fracture patients from a single institution who received suture bridge fixation between July 13, 2010, and February 2, 2022, was performed. Patient data was obtained from patient records in the electronic health record. Univariate analysis, including chi-square and independent t-tests, was used. Complications included delayed wound healing, infection, hardware loosening, and non-union. ResultsThere were no significant differences in demographics, comorbidities, primary or other procedures, loss of fixation, and neuropathy between groups. There was also no difference within the distribution of the mechanism of injury, affected side, or Weber classification. Finally, the rate of complication and complication type showed no significant differences between patients 60 years and older versus 60 years and younger. Complication rates and types in patients > 60 years versus < 60 years were not significantly different. ConclusionThe use of the suture bridge fixation in patients > 60 years may not lead to an increased risk of complications and appears to be safe for use.

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Factors associated with adverse events after distal tibiofibular syndesmosis fixation

Cited by 7 publications

References 25 publications

Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography

Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography

Articular Cartilage of the Syndesmosis: Avoiding Iatrogenic Cartilage Injury During Syndesmotic Fixation

Transosseous Fixation of the Distal Tibiofibular Syndesmosis: Comparison of Interosseous Suture and Endobutton Across Age Groups

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