Medial Clamp Tine Positioning Affects Ankle Syndesmosis Malreduction

Cosgrove, Christopher T.; Putnam, Sara M.; Cherney, Steven M.; Ricci, William M.; Spraggs-Hughes, Amanda; McAndrew, Christopher M.; Gardner, Michael J.

doi:10.1097/bot.0000000000000882

Cited by 50 publications

(36 citation statements)

References 44 publications

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“…Our own data showed a lower malpositioning and correction rate of 7% which may be explained by the generally direct visualization of the syndesmosis stabilisation. Another surgical parameter that significantly influences the reduction result is the positioning of the reduction forceps in the anterior third of the tibia [26].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Three-Dimensional Imaging in Ankle Syndesmotic Reduction.

Beck

Brunk

Wichelhaus

et al. 2020

Preprint

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PurposeInjuries of the distal syndesmosis in ankle fractures are traditionally treated with a temporary adjusting screw fixation. Conventional fluoroscopic and X-ray examinations cannot reliably diagnose malpositions of the fixed tibiofibular syndesmosis. Postoperative computer tomography allows a reliable control of the transfixed region. The aim of the study was to clarify whether an intraoperative 3D image intensifier examination can detect malpositions of the syndesmosis already intraoperatively and whether the examination has an influence on the postoperative revision rate.MethodsIn 200 patients with tibiofibular syndesmosis injuries, an intraoperative 3D scan was performed after reduction of the distal tibiofibular syndesmosis and placement of the adjusting screw. Postoperative computer tomography of both ankle joints was performed in all patients.Results15% of all intraoperative 3D scans (30 patients) showed a finding requiring correction in the area of the ankle fork. In 7% of the cases, a malposition of the fibula in the tibial incisura requiring correction was found. Further corrections were necessary due to the extent and position of the osteosynthesis material (7%) and for the removal of joint bodies (1%). Postoperative computer tomographies of the ankle joints showed no deformities requiring revision.ConclusionAn intraoperative 3D scan allows a reliable assessment of the injured ankle region and reduces the postoperative revision rate. This makes a postoperative routine CT examination of the ankle joint dispensable.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Three-Dimensional Imaging in Ankle Syndesmotic Reduction.

Beck

Brunk

Wichelhaus

et al. 2020

Preprint

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“…Our findings that fibular malreduction was minimal when the medial tine of the reduction clamp was placed anteriorly on the medial tibia confirm clinical findings by Cosgrove et al in which there was a 0%-11% incidence of sagittal plane malreduction when the medial tine was placed on the anteromedial tibial surface in comparison to a 60% incidence of malreduction when that medial tine was placed posteromedially. 6…”

Section: Discussionmentioning

confidence: 99%

Achilles Tension Mitigates Fibular Malalignment Measured in Cadaveric Studies of Syndesmotic Clamping

et al. 2019

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Background: Fibular malreduction is becoming a commonly recognized complication of surgical repair of the syndesmosis when a reduction clamp is used. The goal of this work was to determine the interdependent effects of transsyndesmotic reduction clamp position and applied compression force on fibular alignment in a realistic cadaveric preparation of complete syndesmotic injury. Methods: Six through-the-knee cadaveric specimens were CT scanned intact, with the distal syndesmosis fully destabilized, and with 53, 102, and 160 N clamping forces each applied along an anteriorly, centrally, and posteriorly directed transsyndesmotic axis. Testing was repeated incorporating 178 N of Achilles tendon tension using all 3 clamping forces applied along the centrally directed axis. Fibular reduction was automatically quantified from CT scan–generated bony surfaces as rotation of the fibula around the tibia, rotation of the fibula within the incisura, medial/lateral fibular displacement, and anterior/posterior fibular displacement. Results: Transsyndesmotic clamping along the anteriorly directed axis resulted in the best reduction quality by all 4 quantified measures. Along the centrally and posteriorly directed axes, progressively greater forces caused significantly greater sagittal plane fibular malreduction. Addition of Achilles tension reduced the magnitude of fibular malreduction and overcompression. Conclusion: Placing the medial tine of a transsyndesmotic reduction clamp on the anterior medial tibia resulted in the most accurate syndesmotic reduction and provided some protection against overcompression with large reduction clamp forces. Achilles tension appeared to contribute to reduction, decreasing the magnitude of measured malreduction from clamping. Clinical relevance: Previous studies estimating fibular malpositioning in cadaveric models that lacked passive muscle tension may have overestimated expected magnitudes of malalignment in patients treated with syndesmotic clamping. However, syndesmotic malreduction, particularly in the sagittal plane, was a real complication of syndesmotic clamping that was reduced by using an anterior position of the medial tine on the tibia.

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“…Previous studies by the senior author (MJG) have sought to promote the safe use of reduction clamps to generate an indirect reduction, by optimizing both proper clamp tine positioning 44 and reduction force. 28 Despite the conclusions in this study, some surgeons will still choose to avoid opening the syndesmosis routinely and are more comfortable with an indirect reduction technique.…”

Section: Discussionmentioning

confidence: 99%