Syndesmosis

OBJECTIVES: To evaluate the utility and diagnostic performance of portable handheld ultrasound for evaluating fibular rotation at the distal tibiofibular articulation after syndesmotic disruption. METHODS: Four above-the-knee cadaveric specimens were included. Syndesmotic disruption was precipitated by transecting the Anterior Inferior Tibiofibular Ligament, Interosseous Ligament, and Posterior Inferior Tibiofibular Ligament. Thereafter, a proximal fibular osteotomy was performed, and three conditions were modeled at the distal syndesmosis: 1) reduced, 2) 5 degree internal rotation malreduction, and 3) 5 degree external rotation malreduction...

BACKGROUND: Syndesmotic injuries are frequently stabilized using syndesmotic screws. Traditionally, these screws were routinely removed during the postoperative period, however recent literature has brought into question the necessity of routine removal, citing no change in functional outcomes and the inherent risks of a second surgery. Our study aimed to compare outcomes of patients undergoing routine syndesmotic screw removal versus those undergoing an on-demand approach to removal...

This case report describes a rare occurrence of talar osteochondroma extending into syndesmosis, causing disruption of the interosseous membrane and the posterior inferior tibiofibular ligament (PITFL). This type of presentation for a talar osteochondroma is the first of its kind reported in the literature based on current knowledge. A detailed preoperative radiological assessment was crucial in planning the surgical approach and preparing for syndesmotic stabilization during the excision. The patient underwent successful and complete excision of the osteochondroma, and the syndesmosis was stabilized using a cortical screw along with anatomical repair of the PITFL...

Background: Wagstaffe fracture constitutes an indirect injury to the AITFL and can precipitate syndesmotic instability. The prevailing fixation methods often involve the use of mini-screws or K-wires, with absorbable suture repair reserved for cases with small or comminuted fragments exhibiting instability. In this study, we devised a mini-plate fixation method capable of securing the fracture fragment irrespective of its size or condition. Methods: A retrospective chart review was conducted on patients who underwent surgery for ankle fractures between May 2022 and October 2023...

INTRODUCTION: The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. MATERIALS AND METHODS: The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis...

PURPOSE: To demonstrate how the use of adjunctive Computed Tomography (CT) can modify diagnosis, treatment options, and operative planning of ankle fractures in comparison with conventional radiographs (CR) in isolation. MATERIALS AND METHODS: A total of 53 patients diagnosed with an ankle fracture between 2011 and 2016, were assessed with CT and CR. Evaluations of the fractures using CR in isolation and CR combined with CT were compared using different readers...

Posterior malleolus fractures (PMFs) (OTA 43B1.1) are frequently seen in combination with fractures of the fibula, medial malleolus, and distal tibia; they can rarely be seen in isolation. PMFs affect the alignment of the ankle mortise and the stability of syndesmosis. Techniques described for fixation of PMFs include open reduction internal fixation through a posterolateral or posteromedial approach or anterior-to-posterior screw fixation. For selected minimally displaced or nondisplaced fractures of the posterior malleolus, we developed a percutaneous technique through the Achilles tendon for the insertion of a posterior-to-anterior cannulated screw...

OBJECTIVES: This study aimed to determine the incidence rate and characterise the location and severity of cartilage lesions in the ankle in elite athletes undergoing suture-button stabilisation for unstable distal syndesmotic injuries using needle arthroscopic examination. The feasibility and safety of ad hoc needle arthroscopy and its assisted interventions were also assessed. METHODS: This prospective case series included elite athletes undergoing surgical stabilisation between April 2021 and June 2023...

BACKGROUND: Pronation-external rotation IV (PER IV) ankle fractures are relatively uncommon among rotational ankle fractures, but they are the most severe type. Although recent studies have shown satisfactory functional recovery in PER IV after surgical treatment, the different outcomes between fracture patterns and equivalent fracture patterns have not yet been evaluated. This study aims to compare short-term outcomes in PER IV ankle injuries between fracture patterns and equivalent fracture patterns...

This review article discusses the current evidence on the management of chronic syndesmotic instability. Conservative treatment has a limited role, and surgical intervention is most commonly reported as the mainstay of treatment, however the literature consists of small case series and descriptions of operative techniques, and thus the evidence base for any treatment is weak. Surgical options include arthroscopic debridement alone, static fixation with cortical screws, dynamic fixation with suture-button devices, and ligamentous repair or augmentation...

No abstract text is available yet for this article.

Background Ankle fractures constitute 10% of all traumatic fractures in clinical practice. Concurrent tibiotalar dislocations form 21-36% of all ankle fractures. Although mechanism of injury is similar to non-dislocated ankle fractures, fracture-dislocations cause more extensive bone and soft tissue damage. Treatment is a challenge for orthopedic surgeons due to concomitant pathologies. It is associated with malreduction, chronic pain and most importantly, posttraumatic osteoarthritis. We aimed to investigate the relationship between ankle osteoarthritis radiographic stage and clinical outcomes...

BACKGROUND: Difficulties in the accurate evaluation of tibiofibular clear space in plain radiographs are diagnostic problems in the clinical setting of syndesmosis injury. This study aimed to quantify the anterior tibiofibular gap (ATFG) with weight-bearing using ultrasonography. METHODS: In total, 32 healthy adults (16 men and 16 women) with 64 feet participated in this cross-sectional study. The ATFG was measured along the anterior inferior tibiofibular ligament for a US assessment conducted in both sitting and standing postures...

OBJECTIVE: We always confirm the diagnosis of syndesmotic injury with a Hook test for all ankle fractures and fixed if necessary. Then, we noticed a discrepancy between preoperative radiology and the Hook test. Moreover, we want to report the reliability of syndesmotic fixation decisions with Hook test and preoperative radiology. METHODS: A total of 37 surgically treated patients with isolated Weber type C ankle fractures were included in the study. In all patients, the syndesmosis joint was injured in preoperative computed tomography and X-ray imaging...

No abstract text is available yet for this article.

Lateral ligament injuries are the most common injuries of the ankle joint and are usually treated with early weight bearing after a short period of immobilization. If the clinical presentation is suspicious, additional injuries to the deltoid ligament complex and the syndesmosis should be considered. The indications for additional diagnostics should be generously applied. Injuries to the deltoid ligament usually occur as part of a complex ankle injury and should also be addressed in the surgical treatment of accompanying injuries...

Introduction Distal tibiofibular joint (DTFJ) injuries are commonly encountered in patients with ankle fractures. Achieving optimal fixation is mandatory, but it requires a thorough understanding of the local anatomical relationships. For this reason, we performed a retrospective CT study in healthy ankles to radiologically describe the normal anatomy of the DTFJ and the anatomical relationship of the fibula within the ankle joint. Materials and methods For this study, we retrospectively examined 60 CT scans of healthy, non-injured ankles in a plantigrade position...

Orthopaedic suture buttons have been increasingly used in a variety of procedures, such as syndesmosis stabilization, coracoclavicular ligament repair, anterior cruciate ligament graft fixation, and Lisfranc injury treatment. In many instances, suture-button fixation constructs have shown equivalent, if not superior, outcomes to screw fixation. More recently, suture buttons have been suggested for osseous fixation of the coracoid during the Latarjet procedure, as well as other anterior (or posterior) bone block reconstruction of the glenoid using distal tibial allograft, tricortical iliac crest, or distal clavicle in cases of complex shoulder instability...

INTRODUCTION: Ankle fractures rank as the second most common lower limb fractures, and surgical intervention is essential for unstable ankle fractures. The use of ankle arthroscopy in such cases offers several advantages. This study aim is to assess whether arthroscopy influenced on complication rates in 171 ankle fractures treated with arthroscopic assistance. METHODS: This retrospective epidemiological analysis encompassed adult ankle fractures between December 2018 and December 2021...

Latent or subtle syndesmotic instability is defined as an injury to the syndesmosis which is not apparent on static radiographs of the ankle. Syndesmotic injuries have also been referred to as high ankle sprains. Injury to the syndesmosis typically occurs with collision sports and often involves an external rotation force to the ankle. Diagnosis can be delayed because of negative initial imaging studies. Physical examination tests including the external rotation test, proximal squeeze test, and fibular shuck test can assist in the diagnosis...