Malreduction of syndesmosis—Are we considering the anatomical variation?

Complications in ankle fracture surgery

“…However, recent studies with computed tomography (CT) have revealed, that the rate of syndesmotic malreduction is higher than previously thought , Vasarhelyi et al 2006, Mukhopadhyay et al 2011, Franke et al 2012, Davidovitch et al 2013. 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).…”

“…This is reflected in our findings, since the majority of reoperated cases were due to syndesmotic malreduction (III). Studies have revealed a large variation in syndesmosis anatomy regarding the degree of incisura concavity and the position of the fibula within it (Elgafy et al 2010, Mukhopadhyay et al 2011, Franke et al 2012, Sagi et al 2012. Additionally, recent studies have shown that syndesmotic transfixation may not be necessary in type B ankle fractures despite intraoperatively confirmed syndesmotic disruption (Pakarinen et al 2011c, Kortekangas et al 2014).…”

Complications in ankle fracture surgery

“…Fracture comminution, poor bone quality, and technical errors may predispose a patient to residual displacement following ankle fracture surgery , Lübbeke et al 2012. Recent studies with CT scan have revealed that proper reduction of a syndesmotic injury is especially demanding , Vasarhelyi et al 2006, Miller et al 2009, Mukhopadhyay et al 2011, Franke et al 2012, Sagi et al 2012, Davidovitch et al 2013. In a large population based study with 57,183 patients, the rate of revision ORIF following ankle fracture surgery was 0.8% within the first three postoperative months (Soohoo et al 2009).…”

“…It has recently been demonstrated that proper reduction of syndesmosis is technically more demanding than previously thought (Miller et al 2009, Mukhopadhyay et al 2011, Franke et al 2012, Sagi et al 2012. Direct visualization and open reduction of the syndesmosis has been recommended (Miller et al 2009), since lateral translation and rotational malalignment of the fibula at the level of the syndesmosis may go underdetected (Marmor et al 2011).…”

Acute and Chronic Injuries to the Syndesmosis

“…64 Thus, bilateral imaging can be extremely useful. 65,66 Even after plain radiographs have demonstrated diastasis of the syndesmosis, CT scan can be a useful adjunct on the bony anatomy to guide surgical planning.…”