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https://www.readbyqxmd.com/read/28167065/late-treatment-of-syndesmotic-injuries
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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...
January 13, 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
#7
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
#8
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...
January 18, 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
#9
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
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/28027384/an-anatomical-study-on-the-safe-placement-of-orthopedic-hardware-for-syndesmosis-fixation
#13
Franklin D Shuler, Daniel Woods, Zach Tankersley, Clint McDaniel, Jacob Hamm, Justin Jones, James Denvir, Brian Czarkowski
Articular cartilage and bony contact at the distal tibiofibular cartilage contact zone (TFCCZ) is variable. The appropriate placement of syndesmotic hardware would benefit from a more accurate characterization of the proximal extent of the TFCCZ allowing surgeons to place hardware that simultaneously improves biomechanical stability and decreases the risk of iatrogenic cartilage damage. In addition, Ilizarov wire fixation through the distal fibula and tibia can pass through the syndesmosis recess. Anatomically defining the proximal extent of this recess can help decrease the risk of inadvertent capsular penetration...
December 27, 2016: Orthopedics
https://www.readbyqxmd.com/read/28005114/an-update-on-management-of-syndesmosis-injury-a-national-us-database-study
#14
James C Carr, Brian C Werner, Seth R Yarboro
We conducted a study to determine the incidence of syndesmotic injury and stabilization within various ankle fracture patterns along with the rate of syndesmotic implant removal. All data were obtained from a publicly available for-fee healthcare database, the PearlDiver Patient Records Database. Current Procedural Terminology (CPT) codes were used to search the database for cases of fixation of lateral malleolus, bimalleolar, and trimalleolar fractures in addition to syndesmotic fixation and implant removal...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28002322/the-effect-of-polydeoxyribonucleotide-prolotherapy-on-posterior-tibial-tendon-dysfunction-after-ankle-syndesmotic-surgery-a-case-report
#15
Tae-Ha Lim, Hyung Rae Cho, Keum Nae Kang, Chang Joon Rhyu, Sung Won Chon, Young Su Lim, Jee In Yoo, Jung-Won Kim, Young Uk Kim
RATIONALE: Ankle syndesmotic injuries occasionally require long-term therapy for recovery and can result in tendon injury. Posterior tibial tendon dysfunction (PTTD) is an acquired deformity that can cause flatfoot deformity. The current nonoperative management of PTTD includes nonsteroidal antiinflammatory drugs (NSAIDs), orthopedic devices. Although various treatment options have been attempted, optimal treatments for each stage of the condition are debated. Polydeoxyribonucleotide (PDRN) is effective in healing of chronic wounds associated with tissue damage by attracting tissue growth factors...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27920331/3d-model-analysis-of-ankle-flexion-on-anatomic-reduction-of-a-syndesmotic-injury
#16
Jason M Schon, Jacob D Mikula, Jonathon D Backus, Melanie B Venderley, Grant J Dornan, Robert F LaPrade, Thomas O Clanton
BACKGROUND: The effect of ankle positioning during suture-button fixation for syndesmosis repair on range of motion (ROM) and anatomic reduction has yet to be investigated. The purpose of this cadaveric study was to compare the effects of 3 different ankle positions during suture-button repair on volumetric reduction of the syndesmosis, fibular displacement, and ROM of the ankle using 3-dimensional computed tomography (CT) analysis. The null hypothesis was that ankle position during fixation would not affect syndesmotic volume restoration, fibular displacement, or ROM...
December 5, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27903794/accuracy-and-measurement-error-of-the-medial-clear-space-of-the-ankle
#17
Ogheneochuko Metitiri, Mohammad Ghorbanhoseini, David Zurakowski, Mary G Hochman, Ara Nazarian, John Y Kwon
BACKGROUND: Measurement of the medial clear space (MCS) is commonly used to assess deltoid ligament competency and mortise stability when managing ankle fractures. Lacking knowledge of the true anatomic width measured, previous studies have been unable to measure accuracy of measurement. The purpose of this study was to determine MCS measurement error and accuracy and any influencing factors. METHODS: Using 3 normal transtibial ankle cadaver specimens, deltoid and syndesmotic ligaments were transected and the mortise widened and affixed at a width of 6 mm (specimen 1) and 4 mm (specimen 2)...
November 29, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27900268/management-of-syndesmotic-injuries-what-is-the-evidence
#18
REVIEW
Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke
Ankle fractures are accompanied by a syndesmotic injury in about 10% of operatively treated ankle fractures. Usually, the total rupture of the syndesmotic ligaments with an external rotation force is associated with a Weber type B or C fracture or a Maisonneuve fracture. The clinical assessment should consist of a comprehensive history including mechanism of injury followed by a specific physical examination. Radiographs, and if in doubt magnetic resonance imaging, are needed to ascertain the syndesmotic injury...
November 18, 2016: World Journal of Orthopedics
https://www.readbyqxmd.com/read/27890337/a-double-button-adjustable-loop-device-is-biomechanically-equivalent-to-tension-band-wire-in-the-fixation-of-transverse-patellar-fractures-a-cadaveric-study
#19
Fucai Han, Christopher Jon Pearce, David Q K Ng, Amit K Ramruttun, Desmond Y R Chong, Diarmuid Murphy, Chin Tat Lim, Bernard C S Lee
INTRODUCTION: Tension-band wire fixation of patellar fractures is associated with significant hardware-related complications and infection. Braided polyester suture fixation is an alternative option. However, these suture fixations have higher failure rates due to the difficulty in achieving rigid suture knot fixation. The Arthrex syndesmotic TightRope, which is a double-button adjustable loop fixation device utilizing a 4-point locking system using FibreWire, may not only offer stiff rigid fixation using a knotless system, but may also obviate the need for implant removal due to hardware related problems...
February 2017: Injury
https://www.readbyqxmd.com/read/27886685/posterior-malleolus-fractures
#20
REVIEW
Shay Tenenbaum, Nachshon Shazar, Nathan Bruck, Jason Bariteau
Posterior malleolus fractures vary in morphology. A computed tomography scan is imperative to evaluate fragment size, comminution, articular impaction, and syndesmotic disruption. Despite an increasing body of literature regarding posterior malleolus fractures, many questions remain unanswered. Although, historically, fragment size guided surgical fixation, it is becoming evident that fragment size should not solely dictate treatment. Surgical treatment should focus on restoring ankle joint structural integrity, which includes restoring articular congruity, correcting posterior talar translation, addressing articular impaction, removing osteochondral debris, and establishing syndesmotic stability...
January 2017: Orthopedic Clinics of North America
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