The effect of the ankle syndesmosis reduction quality on the short-term functional outcome following ankle fractures

Kaftandziev, Igor; Bakota, Bore; Trpeski, Simon; Arsovski, Oliver; Spasov, Marko; Čretnik, Andrej

doi:10.1016/j.injury.2021.04.047

Cited by 7 publications

(3 citation statements)

References 35 publications

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“…There was a strong association between the quality of the reduction and short-term functional outcomes, and patients with anatomically reduced syndesmosis had better VAS and AOFAS scores. 108 In pure ligamentous SI, the need for operative stabilization of syndesmosis is almost always established pre-operatively. However in the presence of ankle fractures the presence of syndesmotic instability needs to be judged before fixing isolated fibular fractures and after fixing fibular, bimalleolar or trimalleolar fractures.…”

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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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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“…Using standard reference points, Bhimani et al 36 found that 3-dimensional volumetric measurements of the syndesmosis were more accurate than simple distance measurements underscoring the importance of tomographic imaging in the evaluation of potential subtle syndesmotic injuries. Kaftandziev et al 37 found a correlation between the CT appearance of reduced or malreduced syndesmoses with American Orthopaedic Foot And Ankle (AOFAS) and visual analog scale (VAS) scores.…”

Section: Computed Tomographymentioning

confidence: 99%

Imaging Modalities to Diagnose, Follow, and Assess Treatment of Chronic Ankle Instability

Sofka¹

2022

Techniques in Foot &Amp; Ankle Surgery

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“…14,15 Measuring the accuracy of tibiofibular reduction has been challenging, but bilateral postoperative CT imaging is a commonly used method. [16][17][18] The use of CT is more sensitive compared with the use of conventional radiographs. 19 When analyzing CT images, there are multiple methods to assess syndesmotic reduction, including the talar dome angle as described by Nault et al 15,[20][21][22][23][24][25][26][27] In addition, not only can incorrect reduction of the fibula in the incisura lead to rotational deformities, an incorrect rotational reduction of the fibula fracture leads to a rotational deformity.…”

Section: Introductionmentioning

confidence: 99%

Measuring external rotation of the fibula and fibular length in bilateral CT scans: how reliable is this method?

Penning,

Molendijk,

Halm

et al. 2024

Journal of Orthopaedic Trauma

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Objective. During ankle fracture surgery, goals include accurate reduction and fixation of the tibiofibular joint and fibular length. Bilateral postoperative computed tomography (CT) can be performed to assess syndesmotic reduction, the talar dome angle and fibular length.. The study aim is to compare side-to-side differences of the fibular rotation and fibular length using bilateral CT’s of uninjured ankles. Methods. We included patients with bilateral CT scans of uninjured ankles and measured external rotation using the Nault talar dome method and fibular length using the coronal method of Prior et al. The average, difference, and ratio (injured side/healthy side) and inter-observer variability were calculated. Results. There were 83 patients included (166 ankles, mean age 47 years, 77.1% male). A random set of 66 ankles (33 CT scans) were used to measure inter-observer variability. The mean degrees of external rotation ranged from 6.6 to 7.7, mean difference from 1.4 to 3.4 degrees, mean ratio from 1.1 to 1.5, inter-observer variability from 0.27 to 0.65. For fibular length, the mean ranged from 24.6 to 25.8 mm, mean difference in fibular length ranged from 0.5 to 2.1 mm, mean ratio ranged from 1.0 to 1.1 mm and inter-observer variability ranged from 0.45 to 0.73. Conclusion. Using bilateral ankle CTs, mean differences in fibular rotation using the Nault talar dome method were 1.4 to 3.4 degrees. The distal fibular length had a mean difference between both sides of 0.5 to 2.1mm. Even though the ICC’s were low, the inter-leg differences between patients were small, making them useful for clinical practice. Level of evidence. Diagnostic level III. See Instructions for Authors for a complete description of levels of evidence.

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The effect of the ankle syndesmosis reduction quality on the short-term functional outcome following ankle fractures

Cited by 7 publications

References 35 publications

Instability of the distal tibiofibular syndesmosis

Instability of the distal tibiofibular syndesmosis

Imaging Modalities to Diagnose, Follow, and Assess Treatment of Chronic Ankle Instability

Measuring external rotation of the fibula and fibular length in bilateral CT scans: how reliable is this method?

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