Prospective Results of the Modified Glide Path Technique for Improved Syndesmotic Reduction During Ankle Fracture Fixation

Abstract

Background: Malreduction after syndesmotic stabilization occurs in as many as 52% of cases and has been shown to detrimentally affect clinical outcomes. We propose that the modified Glide Path technique reduces the occurrence of syndesmotic malreduction. Methods: This study is a prospective series comparing 16 patients reduced with the modified Glide Path technique with a retrospectively reviewed series of 25 patients reduced with a traditional technique using fluoroscopy and a clamp. The modified Glide Path technique consists of manual reduction of the fibula and placement of a Kirschner wire through the fibula and tibia along the transmalleolar axis. The syndesmosis can then be reduced along the glide path created by the Kirschner wire to prevent posterior or anterior malreduction. Computed tomographic scans of the repaired and contralateral ankles were obtained postoperatively to assess reduction. Results: We found a statistically significant decrease of syndesmotic malreductions using the modified Glide Path technique when compared with technique that did not use a glide path. In our study, 2 of 16 patients (12.5%) had syndesmotic malreductions using the modified Glide Path technique, compared with 11 of 25 patients (44%) with syndesmotic malreductions in the historical cohort. Conclusion: The modified Glide Path technique is a simple method for ankle syndesmotic reduction. The technique has lower rates of malreduction compared with historical methods and may be useful for most operative syndesmotic injuries. Level of Evidence: Level II, prospective cohort study.

Compensation of Dynamic Fixation Systems in the Quality of Reduction of Distal Tibiofibular Joint in Acute Syndesmotic Complex Injuries: A CT-Based Analysis

“…Another reason for DTFJ malreduction could be the applied intraoperative reduction technique. Published techniques included manual (thumb) reduction, 8 , 20 the glide path technique, 12 or the clamp technique. 4 , 24 Up to now, there is no agreement on the most appropriate reduction technique.…”

“Flexible nature of fixation” in syndesmotic stabilization of the inferior tibiofibular joint affects the radiological reduction outcome

“…The authors concluded that malreduction must be dedicated before the final fixation [ 40 ]. In this context, a modified glide path technique for syndesmotic reduction in ankle fracture fixation appears to reduce the rate of malreduction [ 41 ]. The static fixation of the syndesmosis by SYS was indicated by the lack of relevant divergence of the fibular drill channel to the tibial channel, as could have been assumed.…”

Intramedullary osteosynthesis for ankle fractures and distal tibiofibular syndesmotic disruption

“…При использовании методов статической фиксации наблюдали самую высокую частоту мальредукции сустава и поломки имплантата, повторных операций, а в группе динамической фиксации -самую высокую частоту неанатомичной фиксации синдесмоза. В группе комбинированных методов наблюдали самую низкую частоту осложнений, это связано с тем, что данная техника позволяет зафиксировать синдесмоз как в области передней тибиофибулярной связки, так и в области задней тибиофибулярной связки, снижает риск поломки имплантата, неанатомичного сращения, но повышает риск ятрогенного перелома [38][39][40][41].…”