Sagittal ankle position does not affect axial CT measurements of the syndesmosis in a cadaveric model.
Ankle fracture
Ankle ligamentous stability
Computed tomography
Malreduction
Pronation external rotation
Supination external rotation
Tibiofibular relationship
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
05
11
2018
pubmed:
28
5
2019
medline:
3
4
2020
entrez:
29
5
2019
Statut:
ppublish
Résumé
The purpose of this study was to evaluate the effect of ankle plantarflexion and the axial location of measurement on quantitative syndesmosis assessment. Twelve fresh-frozen cadaveric specimens were secured in three positions of ankle plantarflexion (0°, 15°, and 30°) using an ankle-spanning external fixator and underwent CT scans at each position. Syndesmotic measurements were obtained on axial images using three previously described methods (six measurements) at the level of the tibial plafond and 1 cm proximal to the plafond. Method 1 evaluated the distance between the most anterior and posterior aspects of the fibula and tibia. Method 2 measured medial-lateral diastasis of the anterior and posterior aspects of the fibula, and fibular anterior-posterior translation. Method 3 evaluated axial rotation of the fibula. All measurements were performed by two independent observers. Inter-rater reliability of each measurement was evaluated using intra-class coefficients. Repeated measures analysis of variance (RM-ANOVA) was performed to evaluate within-specimen differences in measurements obtained at varying ankle positions. The anterior incisura component of method 1 demonstrated poor-to-moderate inter-rater reliability across all ankle positions and at both measurement locations. Inter-rater reliability was highest for method 2, especially when measured 1 cm proximal to the plafond. Method 3 demonstrated moderate reliability 1 cm proximal to the plafond. After correcting for multiple comparisons, RM-ANOVA and pairwise analysis revealed that none of the measurements changed significantly with varying ankle position. The inter-rater reliability of the most common method of syndesmotic evaluation (method 1) was found to be lower than in previous studies. The most reliable syndesmotic evaluation can be made by measuring diastasis and anteroposterior translation 1 cm proximal to the plafond (method 2). Ankle position from 0° to 30° of plantarflexion did not change the measurements obtained. IV.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this study was to evaluate the effect of ankle plantarflexion and the axial location of measurement on quantitative syndesmosis assessment.
METHODS
METHODS
Twelve fresh-frozen cadaveric specimens were secured in three positions of ankle plantarflexion (0°, 15°, and 30°) using an ankle-spanning external fixator and underwent CT scans at each position. Syndesmotic measurements were obtained on axial images using three previously described methods (six measurements) at the level of the tibial plafond and 1 cm proximal to the plafond. Method 1 evaluated the distance between the most anterior and posterior aspects of the fibula and tibia. Method 2 measured medial-lateral diastasis of the anterior and posterior aspects of the fibula, and fibular anterior-posterior translation. Method 3 evaluated axial rotation of the fibula. All measurements were performed by two independent observers. Inter-rater reliability of each measurement was evaluated using intra-class coefficients. Repeated measures analysis of variance (RM-ANOVA) was performed to evaluate within-specimen differences in measurements obtained at varying ankle positions.
RESULTS
RESULTS
The anterior incisura component of method 1 demonstrated poor-to-moderate inter-rater reliability across all ankle positions and at both measurement locations. Inter-rater reliability was highest for method 2, especially when measured 1 cm proximal to the plafond. Method 3 demonstrated moderate reliability 1 cm proximal to the plafond. After correcting for multiple comparisons, RM-ANOVA and pairwise analysis revealed that none of the measurements changed significantly with varying ankle position.
CONCLUSION
CONCLUSIONS
The inter-rater reliability of the most common method of syndesmotic evaluation (method 1) was found to be lower than in previous studies. The most reliable syndesmotic evaluation can be made by measuring diastasis and anteroposterior translation 1 cm proximal to the plafond (method 2). Ankle position from 0° to 30° of plantarflexion did not change the measurements obtained.
LEVEL OF EVIDENCE
METHODS
IV.
Identifiants
pubmed: 31134373
doi: 10.1007/s00402-019-03209-4
pii: 10.1007/s00402-019-03209-4
pmc: PMC7063590
mid: NIHMS1530284
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
25-31Subventions
Organisme : NIAMS NIH HHS
ID : T32 AR007281
Pays : United States
Références
Acta Orthop Scand. 1983 Aug;54(4):641-7
pubmed: 6422695
J Orthop Trauma. 2012 Jul;26(7):439-43
pubmed: 22357084
J Orthop Trauma. 2000 Jun-Jul;14(5):359-66
pubmed: 10926245
Foot Ankle. 1993 Mar-Apr;14(3):153-8
pubmed: 8491430
J Chiropr Med. 2016 Jun;15(2):155-63
pubmed: 27330520
J Orthop Trauma. 2012 Nov;26(11):659-61
pubmed: 23100079
J Bone Joint Surg Am. 1997 Dec;79(12):1809-15
pubmed: 9409794
Arch Orthop Trauma Surg. 2019 Jun;139(6):787-793
pubmed: 30770996
Foot Ankle Int. 2006 Oct;27(10):788-92
pubmed: 17054878
Foot Ankle Int. 2016 Jun;37(6):627-35
pubmed: 26922668
Foot Ankle Spec. 2019 Jun;12(3):211-217
pubmed: 29607668
J Athl Train. 2001 Jan-Mar;36(1):68-73
pubmed: 16404437
Acta Orthop Scand. 1985 Apr;56(2):103-6
pubmed: 3925709
Skeletal Radiol. 2006 Dec;35(12):935-41
pubmed: 16683157
Foot Ankle Surg. 2018 Jun;24(3):174-184
pubmed: 29409215
J Orthop Trauma. 2010 Jan;24(1):17-23
pubmed: 20035173
J Orthop Trauma. 2005 Feb;19(2):102-8
pubmed: 15677926
Clin Orthop Relat Res. 2010 Apr;468(4):1129-35
pubmed: 19798540
J Bone Joint Surg Am. 2013 Oct 16;95(20):1838-43
pubmed: 24132357
Skeletal Radiol. 2010 Jun;39(6):559-64
pubmed: 19830423
Injury. 2011 Oct;42(10):1073-6
pubmed: 21550047
Foot Ankle. 1993 Oct;14(8):455-8
pubmed: 8253438
J Orthop Trauma. 2007 Oct;21(9):643-6
pubmed: 17921840
J Orthop Trauma. 2013 Nov;27(11):638-41
pubmed: 23287760
Foot Ankle Int. 2015 Sep;36(9):1095-103
pubmed: 25948693
Foot Ankle Int. 2012 Oct;33(10):870-6
pubmed: 23050712
Foot Ankle Int. 1997 Nov;18(11):693-8
pubmed: 9391813
J Bone Joint Surg Br. 1995 May;77(3):435-8
pubmed: 7744931
J Bone Joint Surg Am. 2018 Jan 3;100(1):2-12
pubmed: 29298255
J Orthop Trauma. 2012 Jul;26(7):433-8
pubmed: 22495526
J Orthop Trauma. 2010 Jan;24(1):7-11
pubmed: 20035171
Am J Sports Med. 2012 Dec;40(12):2828-35
pubmed: 23051785
J Orthop Trauma. 2018 Apr;32(4):e123-e128
pubmed: 29401086
J Bone Joint Surg Am. 2015 Dec 2;97(23):1935-44
pubmed: 26631994
J Orthop Trauma. 2015 May;29(5):250-5
pubmed: 25900750
Foot Ankle Int. 2011 Jun;32(6):616-22
pubmed: 21733425