Preoperative Radiographic and CT Findings Predicting Syndesmotic Injuries in Supination-External Rotation-Type Ankle Fractures

Abstract

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs

“…Nevertheless, our results suggested that the displacing force of the injury may be the most important factor for ankle mortise stability. It can be assumed that younger males have better bone density than older males and females; thus, with high energy trauma, younger males are likely to sustain more severe ligamentous injuries prior to a fracture of the lateral malleolus (23). In our population, men were ten years younger than women, had more comminution, and a larger proportion had unstable ankles, even though comminution was a rather rare occurrence (5.2%).…”

“…Alternatively, manual external-rotation (ER) stress radiographs (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), gravity stress tests (16)(17)(18)(19), or weight-bearing radiographs (20)(21)(22) have been used to quantify possible dynamic instability. Computer tomography (CT) has mainly been used in research settings (23,24).…”

A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures

“…Despite the increased interest in intramedullary fibular fixation, there have been no published biomechanical studies investigating the biomechanical properties of the modern fibular rod at present. While most of the existing literature examines the use of the fibular rod in Weber B fibular fractures, we feel that a potentially beneficial fracture pattern to utilize this fixation would be in AO/OTA 44C2 ankle fractures, which typically requires a large dissection and syndesmotic fixation [ 49 , 50 ].…”

Acute and Chronic Injuries to the Syndesmosis

“…Syndesmotic injury has been positively correlated with transverse fractures of the medial malleolus and bimalleolar fractures. 82 Choi and colleagues 83 found that in SER patterns, fracture height (distance between the lowest point of the fracture and the plafond) greater than 7 mm and MCS greater than 4.5 mm were significant preoperative factors associated with syndesmotic injury. The presence of a posterior malleolar fracture is the equivalent of a bony disruption of the PITFL (Fig.…”

“…The bone block was supplemented with a tetracortical syndesmotic screw. Follow-up demonstrated improved average AOFAS scores (75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92) in 12 patients treated greater than 2 years after initial injury with an average follow-up of 25 months.…”