Intraoperative dreidimensionale Bildgebung bei Syndesmosenverletzungen – eine Multicenterstudie der AG Fuß der DGU

Geerling, J.; Mittlmeier, Thomas; Richter, Martinus; Ochman, Sabine; Brunk, Manuela; Zech, Stefan; Buß, Fokko; Haupt, Caroline; Rammelt, Stefan

doi:10.1016/j.fuspru.2016.03.013

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…Numerous studies have revealed malreduction rates of 22% to 52% following assessment of fibular reduction with 2D fluoroscopy or postreduction radiographs after closed reduction 101,108,110-113 , and a rate of 16% after open reduction 112 . Although these numbers could be reduced further using the techniques described above with correct 2D fluoroscopy 51,108 , either 3D fluoroscopy or postreduction CT of both ankles is recommended for control of reduction 51,111,114 .…”

Section: Surgical Techniquementioning

confidence: 99%

Maisonneuve Fractures of the Ankle

2022

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Maisonneuve fractures (MFs), originally described as subcapital (high) fibular fractures with additional injury to the anterior and interosseous tibiofibular ligaments, display a variable injury pattern, ranging from stable to highly unstable fractures.The high incidence of associated fractures of the posterior malleolus, the medial malleolus, and the anterolateral distal tibia (the “anterior malleolus”) as well as the variable position of the fibula in the fibular notch (FN) warrant preoperative examination via computed tomography (CT).The main goal of treatment is anatomic reduction of the distal fibula into the FN, which requires prior reduction of displaced posterior malleolar fractures, if present, to restore the integrity of the FN.Open reduction of the distal fibula into the FN and fixation with 2 transsyndesmotic screws or fixation with a screw(s) and suture-button implant, under direct vision, on the lateral aspect of the ankle joint and anterior tibiofibular alignment are preferred over closed reduction to avoid sagittal or rotational malpositioning, which is associated with an inferior outcome.Intra- or postoperative 3D CT visualization is essential for assessment of the accuracy of the reduction of the distal fibula into the FN.

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Section: Surgical Techniquementioning

confidence: 99%

Maisonneuve Fractures of the Ankle

2022

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“…With complex fracture patterns, intraoperative 3-dimensional (3-D) fluoroscopy is beneficial, if available. 40 In case of doubt, postoperative CT scanning of both ankles is recommended. 13 The posterior tibial fragment can alternatively be fixed indirectly from the front with anteroposterior screws with the patient supine.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Fixation of Quadrimalleolar Fractures of the Ankle

Rammelt

Bartoníček

Kroker

et al. 2021

Journal of Orthopaedic Trauma

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We present a technique of fixation of trimalleolar fractures with additional fracture of the anterior tibial tubercle ("quadrimalleolar") or anterior fibular rim ("quadrimalleolar equivalent"). Twenty-four patients with a mean age of 60 years were treated with open reduction and internal fixation of all 4 malleoli. There were 17 quadrimalleolar and 6 quadrimalleolar equivalent fractures. One patient had both anterior tibial and fibular avulsion fracture in addition to a trimalleolar ankle fracture. Surgical approaches and internal fixation were tailored individually. Twenty patients were operated in the prone position with direct fixation of the posterior malleolus and 4 patients in the supine position with anterior to posterior screw fixation of the posterior malleolus. After fixation of al 4 malleoli, only 1 patient (4%) required a syndesmotic screw for residual syndesmotic instability on intraoperative testing. There were no infections and no wound healing problems. All patients went on to solid union. Nineteen patients (79%) were followed for a mean of 77 months (range, 15-156 months). The Foot Function Index averaged 15 (range, 50 to 0), the Olerud and Molander Score averaged 79 (range, 45-100), and the American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Scale averaged 87 (range, 39-100). Fixation of the anterior and posterior tibial fragments increases syndesmotic stability by providing a bone-to-bone fixation. Anatomic reduction of the anterior and posterior tibial rim restores the physiological shape of the tibial incisura and therefore facilitates fibular reduction.

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