Suture button versus syndesmotic screw in ankle fractures - evaluation with 3D imaging-based measurements.
3D imaging
3D measurement
Suture button
Syndesmosis
Syndesmotic screw
Tibio-fibular
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
22 Nov 2021
22 Nov 2021
Historique:
received:
13
06
2021
accepted:
02
11
2021
entrez:
23
11
2021
pubmed:
24
11
2021
medline:
25
11
2021
Statut:
epublish
Résumé
Inadequate reduction of syndesmotic injuries can result in disabling clinical outcomes. The aim of the study was to compare syndesmosis congruity after fixation by syndesmotic screws (SYS) or a suture button system (SBS) using three-dimensional (3D) computed imaging techniques. In a retrospective single-center study, patients with unilateral stabilization of an ankle fracture with a syndesmotic injury and post-operative bilateral CT scans were analyzed using a recently established 3D method. The side-to-side differences were compared for tibio-fibular clear space (∆CS), translation angle (∆α), and vertical offset (∆z) among patients stabilized with syndesmotic screws or suture button system. Syndesmotic malreduction was defined for ∆CS > 2 mm and for |∆α| > 5°. ∆CS and ∆α were correlated with two-dimensional (2D) measurements. Eighteen patients stabilized with a syndesmosis screw and 29 stabilized with a suture button system were analyzed. After stabilization, both groups revealed mild diastasis (SYS: mean ∆CS 0.3 mm, SD 1.1 mm vs SBS: mean ∆CS 0.2 mm, SD 1.2 mm, p = 0.710). In addition, both stabilization methods showed slight dorsalization of the fibula (SYS: mean ∆α 0.5°, SD 4.6° vs SBS: mean ∆α 2.1°, SD 3.7°, p = 0.192). Also, restoration of the fibula-to-tibia length ratio also did not differ between the two groups (SYS: mean Δz of 0.5 mm, SD 2.4 mm vs SBS: mean Δz of 0 mm, SD 1.2 mm; p = 0.477). Malreduction according to high ∆α was most common (26% of cases), with equal distribution between the groups (p = 0.234). ∆CS and ∆α showed good correlation with 2D measurements (ρ = 0.567; ρ = 0.671). This in vivo analysis of post-operative 3D models showed no differences in immediate post-operative alignment after syndesmotic screws or suture button system. Special attention should be paid to syndesmotic malreduction in the sagittal orientation of the fibula in relation to the tibia in radiological control of the syndesmotic congruity as well as intra-operatively.
Sections du résumé
BACKGROUND
BACKGROUND
Inadequate reduction of syndesmotic injuries can result in disabling clinical outcomes. The aim of the study was to compare syndesmosis congruity after fixation by syndesmotic screws (SYS) or a suture button system (SBS) using three-dimensional (3D) computed imaging techniques.
METHODS
METHODS
In a retrospective single-center study, patients with unilateral stabilization of an ankle fracture with a syndesmotic injury and post-operative bilateral CT scans were analyzed using a recently established 3D method. The side-to-side differences were compared for tibio-fibular clear space (∆CS), translation angle (∆α), and vertical offset (∆z) among patients stabilized with syndesmotic screws or suture button system. Syndesmotic malreduction was defined for ∆CS > 2 mm and for |∆α| > 5°. ∆CS and ∆α were correlated with two-dimensional (2D) measurements.
RESULTS
RESULTS
Eighteen patients stabilized with a syndesmosis screw and 29 stabilized with a suture button system were analyzed. After stabilization, both groups revealed mild diastasis (SYS: mean ∆CS 0.3 mm, SD 1.1 mm vs SBS: mean ∆CS 0.2 mm, SD 1.2 mm, p = 0.710). In addition, both stabilization methods showed slight dorsalization of the fibula (SYS: mean ∆α 0.5°, SD 4.6° vs SBS: mean ∆α 2.1°, SD 3.7°, p = 0.192). Also, restoration of the fibula-to-tibia length ratio also did not differ between the two groups (SYS: mean Δz of 0.5 mm, SD 2.4 mm vs SBS: mean Δz of 0 mm, SD 1.2 mm; p = 0.477). Malreduction according to high ∆α was most common (26% of cases), with equal distribution between the groups (p = 0.234). ∆CS and ∆α showed good correlation with 2D measurements (ρ = 0.567; ρ = 0.671).
CONCLUSION
CONCLUSIONS
This in vivo analysis of post-operative 3D models showed no differences in immediate post-operative alignment after syndesmotic screws or suture button system. Special attention should be paid to syndesmotic malreduction in the sagittal orientation of the fibula in relation to the tibia in radiological control of the syndesmotic congruity as well as intra-operatively.
Identifiants
pubmed: 34809628
doi: 10.1186/s12891-021-04834-0
pii: 10.1186/s12891-021-04834-0
pmc: PMC8609744
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
970Informations de copyright
© 2021. The Author(s).
Références
J Orthop Surg Res. 2018 Nov 12;13(1):283
pubmed: 30419933
BMC Med Imaging. 2021 Mar 6;21(1):41
pubmed: 33676399
Iowa Orthop J. 2013;33:40-6
pubmed: 24027459
Foot Ankle Surg. 2019 Apr;25(2):180-185
pubmed: 29409288
Clin Orthop Relat Res. 2004 Jun;(423):227-34
pubmed: 15232454
J Bone Joint Surg Am. 1997 Dec;79(12):1809-15
pubmed: 9409794
Foot Ankle Int. 2015 Sep;36(9):1095-103
pubmed: 25948693
Foot Ankle Surg. 2020 Apr;26(3):265-272
pubmed: 30992183
J Bone Joint Surg Am. 2018 Jan 3;100(1):2-12
pubmed: 29298255
J Clin Orthop Trauma. 2021 May 15;18:216-223
pubmed: 34040978
Bone Joint J. 2020 Feb;102-B(2):212-219
pubmed: 32009435
Am J Sports Med. 2012 Dec;40(12):2828-35
pubmed: 23051785
Foot Ankle Surg. 2020 Jan;26(1):54-60
pubmed: 30503612
J Foot Ankle Surg. 2016 Sep-Oct;55(5):985-90
pubmed: 27449525
J Orthop Trauma. 2012 Jul;26(7):439-43
pubmed: 22357084
Int Orthop. 2020 Oct;44(10):2095-2100
pubmed: 32440814
J Bone Joint Surg Am. 2012 Aug 1;94(15):1386-90
pubmed: 22854991
Foot Ankle Int. 2017 Feb;38(2):208-214
pubmed: 27733556
Foot Ankle Int. 2009 May;30(5):419-26
pubmed: 19439142
J Bone Joint Surg Am. 2011 Nov 16;93(22):2057-61
pubmed: 22262376
BMC Musculoskelet Disord. 2017 Jul 4;18(1):286
pubmed: 28676078
J Orthop Trauma. 2019 Aug;33(8):397-403
pubmed: 30973504
J Bone Joint Surg Am. 2013 Oct 16;95(20):1838-43
pubmed: 24132357
J Orthop Trauma. 2015 Sep;29(9):410-3
pubmed: 25635361
Injury. 2011 Oct;42(10):1073-6
pubmed: 21550047
J Orthop Trauma. 2019 Nov;33(11):531-537
pubmed: 31633643
Eur J Radiol. 2019 Mar;112:222-228
pubmed: 30777215
J Orthop Trauma. 2014 Apr;28(4):205-9
pubmed: 23899768
J Orthop Trauma. 2018 Jan;32 Suppl 1:S1-S170
pubmed: 29256945
Foot Ankle Int. 2006 Oct;27(10):788-92
pubmed: 17054878
Injury. 2015;46(6):1119-26
pubmed: 25769201
Injury. 2012 Jun;43(6):838-42
pubmed: 22036451
J Foot Ankle Surg. 2019 Sep;58(5):946-953
pubmed: 31474406
Foot Ankle Int. 2018 Mar;39(3):376-386
pubmed: 29171283
Am J Sports Med. 2019 Sep;47(11):2764-2771
pubmed: 30475639
Orthopedics. 2015 Nov;38(11):e1001-6
pubmed: 26558664
Foot Ankle Int. 2021 Nov;42(11):1491-1501
pubmed: 34088231
Foot Ankle Surg. 2019 Feb;25(1):51-58
pubmed: 29409257
J Orthop Trauma. 2015 May;29(5):216-23
pubmed: 25260059
Foot Ankle Int. 2018 Dec;39(12):1487-1496
pubmed: 30122077
Surg Radiol Anat. 2003 Nov-Dec;25(5-6):379-86
pubmed: 14504816
Foot Ankle Int. 2016 Dec;37(12):1317-1325
pubmed: 27535086