Forceps Reduction of the Syndesmosis in Rotational Ankle Fractures

Phisitkul, Phinit; Ebinger, T.; Goetz, Jessica E.; Vaseenon, Tanawat; Marsh, J. Lawrence

doi:10.2106/jbjs.k.01726

Cited by 146 publications

(139 citation statements)

References 16 publications

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“…There is substantial anatomic variability in the tibiofibular incisure (Elgafy et al 2010, Mukhopadhyay et al 2011, Lepojärvi et al 2013, and the risk for syndesmotic malreduction is especially high in patients with flatter tibiofibular articulations (Elgafy et al 2010). In these patients, the vector of the reduction clamp is critical for appropriately positioning the fibula within the tibiofibular incisure during syndesmotic reduction (Phisitkul et al 2012).…”

Section: Syndesmosismentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthopaedica

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Section: Syndesmosismentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthopaedica

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“…7 Ideally, the clamp and screw would both be placed along the neutral axis to avoid malreduction. This problem with malreduction caused by off-axis clamp and screw placement has been further demonstrated by Phisitkul et al 8 Miller and colleagues recommended more anterior screw trajectory for a screw through a posterior plate, and a more posterior trajectory for a lateral plate. Needleman 9 has described a glide path technique that uses direct K wire reduction along the neutral anatomic axis to ultimately guide screw fixation along the same axis.…”

Section: Historical Perspectivementioning

confidence: 91%

Center-Center Syndesmosis Fixation Technique

Cancienne¹,

Yarboro²

2015

Techniques in Foot &Amp; Ankle Surgery

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Accurate reduction is a critical component in the surgical treatment of ankle syndesmotic injuries, as it restores the joint anatomy and results in superior clinical outcomes. Data suggest a high incidence of malreduction in the treatment of syndesmotic injuries. This article describes the center-center technique for syndesmosis screw insertion. The technique defines the neutral anatomic axis of the distal tibiofibular joint, and improves the surgeon's ability to determine the ideal start point, clamp position, and screw trajectory. The technique avoids potential malreduction caused by suboptimal clamp and screw placement.Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.Ankle fractures are one of the most common operatively treated injuries for orthopedic surgeons. It has been estimated that approximately 23% of ankle fractures involve damage to the distal tibiofibular syndesmosis. 1 A critical step in the treatment of ankle fractures is accurate reduction of the syndesmosis to restore the overall anatomy and function of the ankle joint and prevent ankle arthritis. 2 Reduction of the syndesmosis has been cited as the only significant predictor of functional outcome in a retrospective review of 51 ankle fractures by Weening and Bhandari. 3 Despite the common occurrence of syndesmotic injuries and the importance of accurate fixation, there is a high incidence of malreduction of the syndesmosis. The rates of syndesmotic malreduction have previously been reported to be between 0% and 16%. 3-5 However, Gardner et al 6 demonstrated a syndesmotic malreduction rate of 52% in ankles treated with traditional screw fixation and evaluated with postoperative computed tomographic (CT) scan. A subsequent study by Miller et al 7 reported a decrease in the malreduction rate to 15% when an open technique and direct visualization were used. Given these unacceptably high rates of malreduction, surgeons have sought to reevaluate and improve upon the techniques and intraoperative imaging used to treat and assess syndesmotic reduction.A commonly used technique for syndesmosis fixation involves stabilization of the tibiofibular joint with a reduction clamp, evaluation of the reduction with 2-dimensional (2D) fluoroscopy, and placement of a trans-syndesmotic screw. Traditional teaching dictates that the surgeon angle the screw at 30 degrees to match the neutral anatomic axis.Cadaveric data indicate that both improper clamp and screw placement can lead to malreduction and overcompression of the syndesmosis. 7 Ideally, the clamp and screw would both be placed along the neutral axis to avoid malreduction. This problem with malreduction caused by off-axis clamp and screw placement has been further demonstrated by Phisitkul et al. 8 Miller and colleagues recommended more anterior screw trajectory for a screw through a posterior plate, and a more posterior trajectory for a lateral plate. Needleman 9 has described a glide path technique that uses direct K wire reduction along ...

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“…100 Another cadaveric study showed that placing a clamp in the neutral anatomic axis reduced the syndesmosis most accurately, although minimal overcompression was observed. 101 The authors use a clamp in some situations; however, they have used manual reduction and stabilization using the thumb to generate the reduction force. This is an emerging technique that may decrease the risk of malreduction associated with a clamp.…”

Section: Clamp Placementmentioning

confidence: 99%