The utilization of intraoperative contralateral ankle images for syndesmotic reduction.
Ankle fracture
Contralateral ankle
Fluoroscopic
Mortise
Reduction
Syndesmosis
Journal
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
ISSN: 1432-1068
Titre abrégé: Eur J Orthop Surg Traumatol
Pays: France
ID NLM: 9518037
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
05
11
2020
accepted:
14
04
2021
pubmed:
24
4
2021
medline:
27
1
2022
entrez:
23
4
2021
Statut:
ppublish
Résumé
To evaluate the variability in ankle syndesmotic morphology on contralateral ankle fluoroscopic images and the reductions obtained utilizing these images. A retrospective cohort study was performed at a level one trauma center including 46 adult patients undergoing operative fixation of malleolar ankle fractures that also had anteroposterior (AP) and lateral fluoroscopic images of the uninjured contralateral ankle intraoperatively. Contralateral and post-fixation fluoroscopic images were used to measure the tibiofibular clear space (TFCS) as a proportion of the superior clear space (SCS) on mortise images and the posterior tibiofibular distance (PTFD) as a proportion of the lateral superior clear space (LSCS) on lateral images. Differences between contralateral and post-fixation ankle measurements were compared between those patients with syndesmotic injuries and those without (control group). The mean TFCS/SCS and PTFD/LSCS ratios measured on contralateral ankle images were 1.2 (95% confidence interval (CI) 1.1 to 1.3; range 0.7 to 1.8) and 1.8 (95% CI 1.5 to 2; range 0.5 to 3.4). The mean difference between the contralateral and post-fixation TFCS/SCS and PTFD/LSCS in patients with and without syndesmotic fixation was 0.07 vs. 0.13 (F-ratio 0.3, p = 0.5) and -0.2 vs 0.5 (F ratio 5.2, p= 0.02). Contralateral syndesmotic measurements varied widely and the utilization of these images allowed for syndesmotic reductions with similar measurements. Intraoperative contralateral ankle images should be considered to assess syndesmotic reduction.
Identifiants
pubmed: 33890171
doi: 10.1007/s00590-021-02984-4
pii: 10.1007/s00590-021-02984-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
347-351Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.
Références
Bartoníček J (2003) Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 25:379–386. https://doi.org/10.1007/s00276-003-0156-4
doi: 10.1007/s00276-003-0156-4
pubmed: 14504816
Hermans JJ, Beumer A, De Jong TAW, Kleinrensink GJ (2010) Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach. J Anat 217:633–645. https://doi.org/10.1111/j.1469-7580.2010.01302.x
doi: 10.1111/j.1469-7580.2010.01302.x
pubmed: 21108526
pmcid: 3039176
Mukhopadhyay S, Metcalfe A, Guha AR et al (2011) Malreduction of syndesmosis—are we considering the anatomical variation? Injury 42:1073–1076. https://doi.org/10.1016/j.injury.2011.03.019
doi: 10.1016/j.injury.2011.03.019
pubmed: 21550047
Ostrum RF, de Meo P, Subramanian R (1995) A critical analysis of the anterior-posterior radiographic anatomy of the ankle syndesmosis. Foot Ankle Int 16:128–131. https://doi.org/10.1177/107110079501600304
doi: 10.1177/107110079501600304
pubmed: 7599729
Nault ML, Marien M, Hébert-Davies J et al (2017) MRI quantification of the impact of ankle position on syndesmosis anatomy. Foot Ankle Int 38:215–219. https://doi.org/10.1177/1071100716674309
doi: 10.1177/1071100716674309
pubmed: 27733557
Liu GT, Ryan E, Gustafson E et al (2018) Three-dimensional computed tomographic characterization of normal anatomic morphology and variations of the distal tibiofibular syndesmosis. J Foot Ankle Surg 57:1130–1136. https://doi.org/10.1053/j.jfas.2018.05.013
doi: 10.1053/j.jfas.2018.05.013
pubmed: 30197255
Cherney SM, Spraggs-Hughes AG, McAndrew CM et al (2016) Incisura morphology as a risk factor for syndesmotic malreduction. Foot Ankle Int 37:748–754. https://doi.org/10.1177/1071100716637709
doi: 10.1177/1071100716637709
pubmed: 26979843
Tonogai I, Hamada D, Sairyo K (2017) Morphology of the incisura fibularis at the distal tibiofibular syndesmosis in the Japanese population. J Foot Ankle Surg 56:1147–1150. https://doi.org/10.1053/j.jfas.2017.05.020
doi: 10.1053/j.jfas.2017.05.020
pubmed: 28927702
Shah AS, Kadakia AR, Tan GJ et al (2012) Radiographic evaluation of the normal distal tibiofibular syndesmosis. Foot Ankle Int 33:870–876. https://doi.org/10.3113/FAI.2012.0870
doi: 10.3113/FAI.2012.0870
pubmed: 23050712
Andersen MR, Diep LM, Frihagen F et al (2019) Importance of syndesmotic reduction on clinical outcome after syndesmosis injuries. J Orthop Trauma 33:397–403. https://doi.org/10.1097/BOT.0000000000001485
doi: 10.1097/BOT.0000000000001485
pubmed: 30973504
Naqvi GA, Cunningham P, Lynch B et al (2012) Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med 40:2828–2835. https://doi.org/10.1177/0363546512461480
doi: 10.1177/0363546512461480
pubmed: 23051785
Warner SJ, Fabricant PD, Garner MR et al (2014) The measurement and clinical importance of syndesmotic reduction after operative fixation of rotational ankle fractures. J Bone Jt Surg - Am 97:1935–1944. https://doi.org/10.2106/JBJS.O.00016
doi: 10.2106/JBJS.O.00016
Koenig SJ, Tornetta P, Merlin G et al (2015) Can we tell if the syndesmosis is reduced using fluoroscopy? J Orthop Trauma 29:e326–e330. https://doi.org/10.1097/BOT.0000000000000296
doi: 10.1097/BOT.0000000000000296
pubmed: 25635357
Dikos GD, Heisler J, Choplin RH, Weber TG (2012) Normal tibiofibular relationships at the syndesmosis on axial CT imaging. J Orthop Trauma 26:433–438. https://doi.org/10.1097/BOT.0b013e3182535f30
doi: 10.1097/BOT.0b013e3182535f30
pubmed: 22495526
Summers HD, Sinclair MK, Stover MD (2013) A reliable method for intraoperative evaluation of syndesmotic reduction. J Orthop Trauma 27:196–200. https://doi.org/10.1097/BOT.0b013e3182694766
doi: 10.1097/BOT.0b013e3182694766
pubmed: 23528828
Schreiber JJ, McLawhorn AS, Dy CJ, Goldwyn EM (2013) Intraoperative contralateral view for assessing accurate syndesmosis reduction. Orthopedics 36:360–361. https://doi.org/10.3928/01477447-20130426-03
doi: 10.3928/01477447-20130426-03
pubmed: 23672891
Coles CP, Tornetta P, Obremskey WT et al (2019) Ankle fractures: An expert survey of orthopaedic trauma association members and evidence-based treatment recommendations. J Orthop Trauma 33:e318–e324. https://doi.org/10.1097/BOT.0000000000001503
doi: 10.1097/BOT.0000000000001503
pubmed: 31335507
Meinberg EG, Agel J, Roberts CS et al (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170. https://doi.org/10.1097/BOT.0000000000001063
doi: 10.1097/BOT.0000000000001063
pubmed: 29256945
Davidovitch RI, Weil Y, Karia R et al (2013) Intraoperative syndesmotic reduction: three-dimensional versus standard fluoroscopic imaging. J Bone Jt Surg - Ser A 95:1838–1843. https://doi.org/10.2106/JBJS.L.00382
doi: 10.2106/JBJS.L.00382
Hsu AR, Gross CE, Lee S (2013) Intraoperative o-Arm computed tomography evaluation of syndesmotic reduction: case report. Foot Ankle Int 34:753–759. https://doi.org/10.1177/1071100712468872
doi: 10.1177/1071100712468872
pubmed: 23637241
Pneumaticos SG, Noble PC, Chatziioannou SN, Trevino SG (2002) The effects of rotation on radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle Int 23:107–111. https://doi.org/10.1177/107110070202300205
doi: 10.1177/107110070202300205
pubmed: 11858329
Cha SW, Bae KJ, Chai JW et al (2019) Reliable measurements of physiologic ankle syndesmosis widening using dynamic 3d ultrasonography: a preliminary study. Ultrasonography 38:236–245
doi: 10.14366/usg.18056