New intra-operative technique for testing the distal tibiofibular syndesmosis

Rajagopalan, Senthilvelan; Upadhyay, Vishal; Taylor, Heath; Sangar, A.

doi:10.1308/rcsann.2010.92.3.258

Cited by 9 publications

(3 citation statements)

References 2 publications

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“…Finally, Wu and colleagues 13 compared transsyndesmotic fixation to DLR for bimalleolar-equivalent ankle fracture while also investigating the utility of an intraoperative “tap” test for diagnosing deltoid ligament injury. The tap test was introduced in 2010 by Rajagopalan and colleagues 14 to identify syndesmotic injury based on the principle of converting the force of tapping into syndesmotic diastasis. Deltoid ligament injury was determined by intraoperative exploration of the deltoid ligaments as well as by the tap test.…”

Section: Resultsmentioning

confidence: 99%

Management of deltoid ligament injuries in acute ankle fracture: a systematic review

James

Dodd

2022

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Background: Deltoid ligament repair (DLR) was historically a common adjunct to ankle fracture fixation; however, prevailing clinical practice is to explore the medial side of the ankle only if reduction is blocked. We performed a systematic review to determine the breadth and quality of the literature evaluating DLR in the context of ankle fractures. Methods: We searched the MEDLINE and Embase databases in May 2020 for English-language articles evaluating DLR versus no repair or syndesmotic fixation in patients with acute ankle fractures. We used descriptive statistics to compare studies and draw conclusions. Results: Of 362 articles identified, 8 (3 randomized controlled trials [RCTs] and 5 retrospective cohort studies) were included in our final analysis. Five studies compared DLR to conservative management, and 3 compared DLR to transsyndesmotic fixation. Functional outcomes were equivalent between groups. Five of the 6 studies that included radiographic outcomes showed a statistically significant decrease in the medial clear space and decreased malreduction rates postoperatively in the DLR groups. Conclusion: High-quality evidence guiding treatment of deltoid ligament injury in acute ankle fractures is lacking; currently available evidence appears to support DLR. Given recent increased interest in DLR and syndesmotic fixation, a comprehensive multicentre RCT is warranted. Although radiographic evidence indicates the potential benefit of DLR, further research is required to establish the superiority of DLR versus clinical equipoise.

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Section: Resultsmentioning

confidence: 99%

Management of deltoid ligament injuries in acute ankle fracture: a systematic review

James

Dodd

2022

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“…111 Tap test is another proven technique to evaluate coronal syndesmotic instability intra-operatively and this technique involves advancing a cortical tap through a drilled hole in the fibula which produces a unidirectional distraction force to the tibia. 112,113 A recent cadaveric study compared the Cotton test and Tap test for the assessment of coronal instability. The Cotton test and Tap test had, respectively, 73.3% and 70% sensitivity, 100% and 90% specificity, and 86.7% and 80% diagnostic accuracy.…”

Section: Operative Treatmentmentioning

confidence: 99%

Instability of the distal tibiofibular syndesmosis

Vohra¹,

Singh²,

Thorat³

et al. 2023

J Orthop Surg (Hong Kong)

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The distal tibiofibular syndesmosis (DTFS) is more frequently injured than previously thought. Early diagnosis and appropriate treatment is essential to avoid long term complications like chronic instability, early osteoarthritis and residual pain. Management of these injuries require a complete understanding of the anatomy of DTFS, and the role played by the ligaments stabilizing the DTFS and ankle. High index of suspicion, appreciating the areas of focal tenderness and utilizing the provocative maneuvers help in early diagnosis. In pure ligamentous injuries radiographs with stress of weight bearing help to detect subtle instability. If these images are inconclusive, then further imaging with MRI, CT scan, stress examination under anesthesia, and arthroscopic examination facilitate diagnosis. An injury to syndesmosis frequently accompanies rotational fractures and all ankle fractures need to be stressed intra-operatively under fluoroscopy after fixation of the osseous components to detect syndesmotic instability. Non-operative treatment is appropriate for stable injuries. Unstable injuries should be treated operatively. Anatomic reduction of the syndesmosis is critical, and currently both trans-syndesmotic screws and suture button fixation are commonly used for syndesmotic stabilization. Chronic syndesmotic instability (CSI) requires debridement of syndesmosis, restoration of ankle mortise with or without syndesmotic stabilization. Arthrodesis of ankle is used a last resort in the presence of significant ankle arthritis. This article reviews anatomy and biomechanics of the syndesmosis, the mechanism of pure ligamentous injury and injury associated with ankle fractures, clinical, radiological and arthroscopic diagnosis and surgical treatment.

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“…Finally, Bi and colleagues examined the diagnostic value of the intraoperative tap test for acute deltoid ligament instability which had been proposed by Rajagopalan et al [12]. In a patient collective with 92 ankle fractures they compared the tap test versus the gravity stress test and performed an open dissection of the deltoid ligament [11].…”

mentioning

confidence: 99%

Focus on foot and ankle

Mittlmeier

2021

Eur J Trauma Emerg Surg

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New intra-operative technique for testing the distal tibiofibular syndesmosis

Cited by 9 publications

References 2 publications

Management of deltoid ligament injuries in acute ankle fracture: a systematic review

Management of deltoid ligament injuries in acute ankle fracture: a systematic review

Instability of the distal tibiofibular syndesmosis

Focus on foot and ankle

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