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https://www.readbyqxmd.com/read/28416851/-one-of-the-pitfalls-in-the-surgical-treatment-of-maisonneuve-fractures-a-case-report
#1
H Q Ji, F Zhou, Y Tian, Z S Zhang, Y Guo, Y Lv, Z W Yang, G J Hou
There exist controversies in the surgical treatment of maisonneuve injury with regard to reduction and fixation of syndesmosis and management of proximal fibular fracture. It is very important for the orthopaedic surgeons to learn more techniques and avoid pitfalls from clinical practice. We summarized the clinical data of 1 failed case, a 20-year-old girl with big body weight who underwent a primary surgery for the treatment of maisonneuve fracture with minimally invasive reduction and fixation of ankle syndesmosis and posterior malleolus and open reduction and internal fixation of medial malleolus, then a revision surgery for the treatment of iatrogenic syndesmotic malreduction with open reduction and re-stabilization of ankle syndesmosis supplemented with open reduction and internal fixation of proximal fibular facture...
April 18, 2017: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/28391516/management-of-acute-injuries-of-the-tibiofibular-syndesmosis
#2
REVIEW
Nicholas M Fort, Amiethab A Aiyer, Jonathan R Kaplan, Niall A Smyth, Anish R Kadakia
The syndesmosis is important for ankle stability and load transmission and is commonly injured in association with ankle sprains and fractures. Syndesmotic disruption is associated with between 5 and 10% of ankle sprains and 11-20% of operative ankle fractures. Failure to recognize and appropriately treat syndesmotic disruption can portend poor functional outcomes for patients; therefore, early recognition and appropriate treatment are critical. Syndesmotic injuries are difficult to diagnose, and even when identified and treated, a slightly malreduced syndesmosis can lead to joint destruction and poor functional outcomes...
April 8, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28390687/overtightening-of-the-syndesmosis-revisited-and-the-effect-of-syndesmotic-malreduction-on-ankle-dorsiflexion
#3
Tyler Gonzalez, Jonathan Egan, Mohammad Ghorbanhoseini, Micah Blais, Aron Lechtig, Brian Velasco, Ara Nazarian, John Y Kwon
BACKGROUND: Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: (1) To assess the effect of compressive syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of motion...
March 25, 2017: Injury
https://www.readbyqxmd.com/read/28336099/direct-fixation-of-fractures-of-the-posterior-pilon-via-a-posteromedial-approach
#4
Harm Hoekstra, Wouter Rosseels, Stefan Rammelt, Stefaan Nijs
The treatment of fractures of the posterior pilon is a timely issue. Restoration of the integrity of the incisura fibularis and subsequent anatomic reduction of the fibula are essential for reconstruction of the ankle mortise after trauma, and syndesmotic stability. Inappropriate treatment ultimately will lead to a poor functional outcome and quality of life. Open reduction and direct internal fixation through a posterolateral or posteromedial approach are increasingly preferred over indirect reduction and anteroposterior screw fixation...
March 19, 2017: Injury
https://www.readbyqxmd.com/read/28321479/novel-anatomical-reconstruction-of-distal-tibiofibular-ligaments-restores-syndesmotic-biomechanics
#5
Jian Che, Chunbao Li, Zhipeng Gao, Wei Qi, Binping Ji, Yujie Liu, Ming Han Lincoln Liow
PURPOSE: To date, there is a paucity of literature on syndesmotic reconstruction techniques that restore both anatomic stability and physiologic syndesmotic biomechanics. In this cadaveric study, (1) a novel syndesmotic reconstruction surgical technique using autogenous peroneus brevis tendon was described and (2) the biomechanical properties of the reconstruction was investigated. METHODS: Ten fresh-frozen lower extremities were used in this study. Reconstruction of the anterior and posterior, as well as the interosseous tibiofibular ligaments was performed with a halved peroneus brevis tendon...
March 20, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28298142/effect-of-complete-syndesmotic-disruption-and-deltoid-injuries-and-different-reduction-methods-on-ankle-joint-contact-mechanics
#6
Jeremy LaMothe, Josh R Baxter, Susannah Gilbert, Conor I Murphy, Sydney C Karnovsky, Mark C Drakos
BACKGROUND: Syndesmotic injuries can be associated with poor patient outcomes and posttraumatic ankle arthritis, particularly in the case of malreduction. However, ankle joint contact mechanics following a syndesmotic injury and reduction remains poorly understood. The purpose of this study was to characterize the effects of a syndesmotic injury and reduction techniques on ankle joint contact mechanics in a biomechanical model. METHODS: Ten cadaveric whole lower leg specimens with undisturbed proximal tibiofibular joints were prepared and tested in this study...
March 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28253941/arthrodesis-of-the-ankle
#7
H Zwipp
About 90 % of all cases of painful posttraumatic ankle arthritis can be very successfully treated with a minor invasive ankle arthrodesis technique by using a small anterior approach and a fixation with four 6. 5 mm screws of which the posteromedial and transfibular one are inserted percutaneously. The results with this standardized procedure have been reported previously as excellent and good in a mid-term run of 6 years (34). This technique leads to a high union rate of 99% (92 of 93) with rapid bone healing within 8 ± 2 weeks, it causes a low minor complication rate of 8 % and enables a significant increase of the AOFAS ankle/hindfoot score (17) from 36 preoperatively to 85 postoperatively as well as a midtarsal movement of 24° ± 16°...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28219637/malreduction-of-syndesmosis-injury-associated-with-malleolar-ankle-fracture-can-be-avoided-using-weber-s-three-indexes-in-the-mortise-view
#8
Kentaro Futamura, Tomonori Baba, Atsuhiko Mogami, Itaru Morohashi, Akio Kanda, Osamu Obayashi, Kazuo Sato, Yasuhisa Ueda, Yoshiaki Kurata, Hideki Tsuji, Kazuo Kaneko
PURPOSE: Malalignment of syndesmosis is generally associated with a poor outcome, yet occurs at a high rate in malleolar ankle fractures. In this study, we examine whether malreduction of syndesmosis injury associated with malleolar ankle fracture can be avoided using Weber's three indexes in the mortise view. MATERIALS AND METHODS: Of 156 patients with malleolar ankle fracture who underwent surgery from December 2012 to March 2016 at two medical facilities, 24 patients who received syndesmotic screw fixation were included in the study...
February 14, 2017: Injury
https://www.readbyqxmd.com/read/28167065/late-treatment-of-syndesmotic-injuries
#9
REVIEW
Michael P Swords, Andrew Sands, John R Shank
Normal syndesmosis anatomy and alignment are essential to ankle function. Although injuries to the syndesmosis are common with ankle injuries, accurate diagnosis and reduction continue to be a challenge. Late reconstruction for syndesmosis is reviewed. A surgical technique for late reconstruction is outlined in detail.
March 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28160934/arthroscopic-quantification-of-syndesmotic-instability-in-a-cadaveric-model
#10
Ross Feller, Todd Borenstein, Amanda J Fantry, Roy Bradley Kellum, Jason T Machan, Florian Nickisch, Brad Blankenhorn
PURPOSE: To investigate whether arthroscopy or stress radiography can identify instability resulting from single-ligament injury of the ankle syndesmosis and to determine whether either modality is capable of differentiating between various levels of ligament injury. METHODS: Syndesmotic/deltoid ligament sectioning was performed in 10 cadaver legs. Arthroscopic evaluation and fluoroscopic stress testing were completed after each sectioning. In group 1 (n = 5), sectioning began with anteroinferior tibiofibular ligament (AITFL), then interosseous membrane (IOM), posteroinferior tibiofibular ligament (PITFL), and deltoid...
February 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28159044/a-simplified-validated-protocol-for-measuring-fibular-reduction-on-ankle-ct
#11
Christopher Patrick Prior, James Christopher Widnall, Amer Kemall Rehman, David Marc Weller, Edward Vaughan Wood
BACKGROUND: Inadequate ankle syndesmotic reduction is a common and important cause of poor outcome after surgery. It is not clear what magnitude or planes of displacement impact most. Many computerised tomography (CT) measurement techniques rely on landmarks that are difficult to reproduce, and none measure all types of mal-positioning in a single protocol. The purpose of this study was to design and validate a protocol for measuring the distal tibio-fibular relationship. METHODS: We devised a method for measuring fibular diastasis, antero-posterior translation (APT) and fibular length on CT images...
March 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28142266/inflammatory-microenvironment-persists-after-bone-healing-in-intra-articular-ankle-fractures
#12
Samuel B Adams, Elizabeth M Leimer, Lori A Setton, Richard D Bell, Mark E Easley, Janet L Huebner, Thomas V Stabler, Virginia B Kraus, Steven A Olson, Dana L Nettles
BACKGROUND: Post-traumatic osteoarthritis (PTOA) is responsible for the majority of cases of ankle arthritis. While acute and end-stage intra-articular inflammation has previously been described, the state of the joint between fracture healing and end-stage PTOA remains undefined. This study characterized synovial fluid (SF) composition of ankles after bone healing of an intra-articular fracture to identify factors that may contribute to the development of PTOA. METHODS: Of an original 21 patients whose SF was characterized acutely following intra-articular ankle fractures, 7 returned for planned hardware (syndesmotic screw) removal after bone healing (approximately 6 months) and consented to a second bilateral SF collection...
January 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28134962/common-foot-and-ankle-injuries-what-not-to-miss-and-how-best-to-manage
#13
Jessica Reissig, Adam Bitterman, Simon Lee
Injuries to the foot and ankle are commonly encountered, especially among athletes, and can lead to morbidity if not managed appropriately. Health care professionals must have a firm understanding of injury anatomy, diagnoses, and management. This article provides a review of lateral talus process fractures, os trigonum injuries, Lisfranc injuries, turf toe, navicular stress fractures, and syndesmotic injuries.
February 1, 2017: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/28131483/simulating-clamp-placement-across-the-trans-syndesmotic-angle-of-the-ankle-to-minimize-malreduction-a-radiological-study
#14
Sara M Putnam, Michael S Linn, Amanda Spraggs-Hughes, Christopher M McAndrew, William M Ricci, Michael J Gardner
BACKGROUND: Ankle fractures associated with syndesmotic injury have a poorer prognosis than those without such an injury. Anatomic reduction of the distal tibiofibular joint restores joint congruency and minimizes contact pressures, yet operative fixation of syndesmotic ankle injuries is frequently complicated by malreduction of the syndesmosis. Current methods of assessing reduction have been shown to be inadequate. As such, additional methods to judge the accuracy of syndesmotic reduction are required...
March 2017: Injury
https://www.readbyqxmd.com/read/28116515/caipirinha-accelerated-space-enables-10-min-isotropic-3d-tse-mri-of-the-ankle-for-optimized-visualization-of-curved-and-oblique-ligaments-and-tendons
#15
Vivek Kalia, Benjamin Fritz, Rory Johnson, Wesley D Gilson, Esther Raithel, Jan Fritz
OBJECTIVES: To test the hypothesis that a fourfold CAIPIRINHA accelerated, 10-min, high-resolution, isotropic 3D TSE MRI prototype protocol of the ankle derives equal or better quality than a 20-min 2D TSE standard protocol. METHODS: Following internal review board approval and informed consent, 3-Tesla MRI of the ankle was obtained in 24 asymptomatic subjects including 10-min 3D CAIPIRINHA SPACE TSE prototype and 20-min 2D TSE standard protocols. Outcome variables included image quality and visibility of anatomical structures using 5-point Likert scales...
January 23, 2017: European Radiology
https://www.readbyqxmd.com/read/28101828/current-trends-in-the-diagnosis-and-management-of-syndesmotic-injury
#16
REVIEW
Matthew L Vopat, Bryan G Vopat, Bart Lubberts, Christopher W DiGiovanni
Ideal management of the various presentations of syndesmotic injury remains controversial to this day. High quality evidentiary science on this topic is rare, and numerous existing studies continue to contradict one another. The primary reasons for these discrepancies are that previous studies have failed to (1) properly distinguish between isolated (non-fractured) and non-isolated injuries, (2) accurately define stable from unstable injuries, and (3) sufficiently differentiate between acute and chronic injuries...
March 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28074301/tightrope-fixation-of-syndesmotic-injuries-in-weber-c-ankle-fractures-a-multicentre-case-series
#17
Amarjit Anand, Ran Wei, Akash Patel, Vikas Vedi, Garth Allardice, Bobby Singh Anand
BACKGROUND: No general consensus has yet been established for the gold standard treatment of ankle syndesmotic complex injuries. Recent literature has documented the success of ankle tightrope fixation for heterogeneous ankle fracture patterns, resulting in syndesmotic complex injuries. We present a multicentre case series assessing the clinical, radiological and functional outcomes of patients with Weber C ankle fractures treated with the Arthrex TightRope(®) fixation system. METHOD: We performed a retrospective analysis of all adult patients with Weber C ankle fractures who were treated with the Arthrex TightRope(®) fixation system at four centres over a 3-year period...
January 10, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28056156/deep-infections-after-syndesmotic-fixation-with-a-suture-button-device
#18
Amanda J Fantry, Seth W O'Donnell, Chris T Born, Roman A Hayda
Suture button devices such as the TightRope (Arthrex, Naples, Florida) have been increasingly used for syndesmotic fixation of ankle fractures. Despite proposed advantages, prior studies have shown equivalent outcomes, with a theoretical decreased need for removal of hardware. Complications of suture button fixation of syndesmotic instability may be underreported and include lateral suture knot inflammation with or without granuloma formation, infection, aseptic osteolysis with widening of the tibial drill tunnels, heterotopic ossification, and osteomyelitis...
January 5, 2017: Orthopedics
https://www.readbyqxmd.com/read/28027658/is-incisura-fibularis-a-reliable-landmark-for-assessing-syndesmotic-stability
#19
Akilesh Anand Prakash
Incisura fibularis (IF) is an important landmark in assessing syndesmotic stability radiologically postinjury. The purpose of this review was to explore the anatomy and morphometrics of this widely used anatomical landmark and to further the understanding of the same. A systematic review was conducted online using PubMed and Google Scholar, per PRISMA guidelines. Predefined eligibility criteria were applied, and the data thus compiled were analyzed. Wide variability in morphometrics and, thus, anatomy of IF were observed in the present review, which was influenced by gender...
December 1, 2016: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/28027655/removal-of-hardware-after-syndesmotic-screw-fixation
#20
Kempland C Walley, Kurt J Hofmann, Brian T Velasco, John Y Kwon
BACKGROUND: While trans-syndesmotic fixation with metal screws is considered the gold standard in treating syndesmotic injuries, controversy exists regarding the need and timing of postoperative screw removal. Formal recommendations have not been well established in the literature and clinical practice is highly variable in this regard. The purpose of this systematic review is to critically examine the most recent literature regarding syndesmotic screw removal in order to provide surgeons an evidence-based approach to management of these injuries...
December 1, 2016: Foot & Ankle Specialist
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