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ankle syndesmosis

John Morellato, Hakim Louati, Andrew Bodrogi, Andrew Stewart, Steven Papp, Allan Liew, Wade Gofton
BACKGROUND/PURPOSE: There have been no studies assessing the optimal biomechanical tension of suture button constructs. The purpose of this study was to assess optimal tensioning of suture button fixation and its ability to maintain reduction under loaded conditions using a stress computed tomography (CT) model. METHODS: Ten cadaveric lower limbs disarticulated at the knee were used. The limbs were placed in a modified ankle load frame that allowed for the application of sustained torsional axial, or combined torsional/axial loads...
October 13, 2016: Journal of Orthopaedic Trauma
Marie-Lyne Nault, Melissa Marien, Jonah Hébert-Davies, G Yves Laflamme, Vincent Pelsser, Dominique M Rouleau, Nayla Gosselin-Papadopoulos, Stéphane Leduc
BACKGROUND: Despite the common occurrence of syndesmotic injuries in ankle trauma, the distal tibiofibular relationship remains poorly understood. The aim of this study was to evaluate the anatomical impact of ankle sagittal positioning on the tibiofibular relationship in intact ankles by using a validated magnetic resonance imaging (MRI)-based measurement system. METHODS: In this radiologic study, 34 healthy volunteers underwent a series of ankle MRIs with the ankle stabilized in 3 positions: neutral position (NP), dorsiflexion (DF), and plantarflexion (PF)...
October 12, 2016: Foot & Ankle International
Fabian Wong, Rebecca Mills, Nadeem Mushtaq, Roland Walker, Samrendu K Singh, Ali Abbasian
INTRODUCTION: Various methods using CT scan have been described to diagnose distal tibiofibular syndesmotic injuries. However, CT scan does not take into account the amount of cartilage within the distal tibiofibular joint and could therefore lead to false positive results. We present the first study correlating the findings of the distal tibiofibular syndesmosis on CT and MRI scans. METHODS: CT and MRI scan of consecutive patients over a period of 18 months, and of a time lapsed less than 12 months between the two imaging modalities, were reviewed...
June 23, 2016: Foot
Thomas O Clanton, Brady T Williams, Jonathon D Backus, Grant J Dornan, Daniel J Liechti, Scott R Whitlow, Adriana J Saroki, Travis Lee Turnbull, Robert F LaPrade
BACKGROUND: Biomechanical data and contributions to ankle joint stability have been previously reported for the individual distal tibiofibular ligaments. These results have not yet been validated based on recent anatomic descriptions or using current biomechanical testing devices. METHODS: Eight matched-pair, lower leg specimens were tested using a dynamic, biaxial testing machine. The proximal tibiofibular joint and the medial and lateral ankle ligaments were left intact...
September 28, 2016: Foot & Ankle International
Thomas O Clanton, Scott R Whitlow, Brady T Williams, Daniel J Liechti, Jonathon D Backus, Grant J Dornan, Adriana J Saroki, Travis Lee Turnbull, Robert F LaPrade
BACKGROUND: Significant debate exists regarding optimal repair for unstable syndesmosis injuries. Techniques range from screw fixation, suture-button fixation, or a combination of the two. In this study, 3 common repairs were compared using a simulated weightbearing protocol with internal and external rotation of the foot. METHODS: Twenty-four lower leg specimens with mean age 54 years (range, 38-68 years) were used for testing. Following creation of a complete syndesmotic injury (AITFL, ITFL, PITFL, interosseous membrane), specimens were repaired using 1 of 3 randomly assigned techniques: (1) one 3...
September 25, 2016: Foot & Ankle International
Jiri Marvan, Valer Dzupa, Martin Krbec, Jiri Skala-Rosenbaum, Radek Bartoska, David Kachlik, Vaclav Baca
INTRODUCTION: Ankle fractures comprise a highly morphologically and etiologically diverse group of injuries, which includes various degrees of impairment of bone and ligamentous structures. The complete synostosis and incomplete bony bridging of tibiofibular syndesmosis are among the local late complications after surgically treated ankle fractures. PATIENTS AND METHOD: 269 patients were evaluated, including 203 patients with Weber type-B fractures, and 66 patients with Weber type-C fractures...
September 7, 2016: Injury
A Jubel, C Faymonville, J Andermahr, S Boxberg, G Schiffer
Background: Ankle fractures are extremely common in the elderly, with an incidence of up to 39 fractures per 100,000 persons per year. We found a discrepancy between intraoperative findings and preoperative X-ray findings. It was suggested that many relevant lesions of the ankle joint in the elderly cannot be detected with plain X-rays. Methods: Complete data sets and preoperative X-rays of 84 patients aged above 60 years with ankle fractures were analysed retrospectively. There were 59 women and 25 men, with a mean age of 69...
September 19, 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Tom Jan Gieroba, Zachary Munn, Peter J Cundy, Nathan Eardley-Harris
The objective of this review is to compare the effectiveness of three fixation methods for acute injuries of the ankle syndesmosis - metal screw fixation, bioabsorbable screw fixation and suture button fixation.The reviewers seek to critically evaluate the available evidence to provide an evidence-based appraisal of the comparative safety and efficacy of the treatment strategies.
August 2016: JBI Database of Systematic Reviews and Implementation Reports
Paul J Switaj, Daniel Fuchs, Mohammed Alshouli, Avinash G Patwardhan, Leonard I Voronov, Muturi Muriuki, Robert M Havey, Anish R Kadakia
BACKGROUND: A lateral approach with open reduction and internal fixation with a plate is a very effective technique for the majority of distal fibular fractures. However, this open approach for ankle fixation may be complicated by wound dehiscence and infection, especially in high-risk patients. An alternative to plating is an intramedullary implant, which allows maintenance of length, alignment, and rotation and which allows for decreased soft tissue dissection. While there has been clinical data suggesting favorable short-term outcomes with these implants, there is no current biomechanical literature investigating this technology in this particular fracture pattern...
2016: Journal of Orthopaedic Surgery and Research
Marie-Lyne Nault, Laurence Gascon, Jonah Hébert-Davies, Stéphane Leduc, G Yves Laflamme, Dennis Kramer
BACKGROUND: The hypothesis of this study is that a sprain or tear of 1 or more of the 3 syndesmotic ligaments will result in a significant change in the osseous anatomy relationship when comparing injured to uninjured syndesmosis. Our secondary objective was to determine whether injuries to the syndesmosis as diagnosed on magnetic resonance imaging (MRI) could be found using static imaging. METHODS: This is a descriptive radiological study of ankle MRI reports over a 12-year period, from 2 different institutions, and divided in two groups: normal and injured syndesmotic ligaments...
September 13, 2016: Foot & Ankle Specialist
Douglas E Lucas, B Collier Watson, G Alex Simpson, Gregory C Berlet, Christopher F Hyer
: Ankle fractures are a common injury treated by orthopaedic surgeons. The distal tibiofibular syndesmosis can be injured during these fractures as well as in isolation. They pose a significant challenge with regard to the diagnosis of instability as well as evaluating reduction after fixation. Multiple studies have demonstrated that traditional radiographic analysis fails to accurately identify syndesmotic diastasis, instability, or malreduction. Ankle arthroscopy has been proposed as an alternative way to evaluate the syndesmosis...
September 9, 2016: Foot & Ankle Specialist
Kaitlin C Neary, Matthew A Mormino, Hongmei Wang
BACKGROUND: In stress-positive, unstable supination-external rotation type 4 (SER IV) ankle fractures, implant selection for syndesmotic fixation is a debated topic. Among the available syndesmotic fixation methods, the metallic screw and the suture button have been routinely compared in the literature. In addition to strength of fixation and ability to anatomically restore the syndesmosis, costs associated with implant use have recently been called into question. PURPOSE: This study aimed to examine the cost-effectiveness of the suture button and determine whether suture button fixation is more cost-effective than two 3...
September 6, 2016: American Journal of Sports Medicine
Ronald G Ray
There are a number of variations in the intra-articular anatomy of the ankle which should not be considered pathological under all circumstances. The anteromedial corner of the tibial plafond (between the anterior edge of the tibial plafond and the medial malleolus) can have a notch, void of cartilage and bone. This area can appear degenerative arthroscopically; it is actually a normal variant of the articular surface. The anterior inferior tibiofibular ligament (AITF) can possess a lower, accessory band which can impinge on the anterolateral edge of the talar dome...
October 2016: Clinics in Podiatric Medicine and Surgery
M Bondi, N Rossi, A Pizzoli, L Renzi Brivio
PURPOSE: Ten percentage of all ankle fractures sustain an associated syndesmotic injury. TightRope is a relatively new technique for syndesmosis fixation, characterized by a non-absorbable FibreWire held tight between two cortical metal buttons. The purpose of this study was to evaluate the results obtained with the use of this device. METHODS: From January 2011 to December 2015, 54 patients with ankle diastases were treated. Eighteen patients were excluded from the study...
August 27, 2016: Musculoskeletal Surgery
William W Schairer, Benedict U Nwachukwu, David M Dare, Mark C Drakos
Standalone open reduction-internal fixation (ORIF) of unstable ankle fractures is the current standard of care. Intraoperative stress radiographs are useful for assessing the extent of ligamentous disruption, but arthroscopic visualization has been shown to be more accurate. Concomitant arthroscopy at the time of ankle fracture ORIF is useful for accurately diagnosing and managing syndesmotic and deltoid ligament injuries. The arthroscopic ankle drive-through sign is characterized by the ability to pass a 2...
April 2016: Arthroscopy Techniques
Jung-Han Kim, Heui-Chul Gwak, Chang-Rack Lee, Hye-Jeung Choo, Jeon-Gyo Kim, Dae-Yoo Kim
The present study compared the quality of reduction and the clinical assessment between screw fixation and suture-button fixation with an ankle fracture accompanied by syndesmosis injury. We studied the clinical and radiologic findings 1 year postoperatively through retrospective examination of 24 patients who had undergone screw fixation from January 2011 to December 2012 and prospective examination of 20 patients who had undergone suture button fixation from January 2013 to May 2014. Regarding the tibiofibular clear space, tibiofibular overlap, and medial clear space, the screw fixation group had improvement from a preoperative mean of 6...
September 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Robert F Ostrum, Matthew C Avery
Rotational ankle fractures are incredibly common, resulting in a wide spectrum of bony and ligamentous injury patterns. After open reduction of an ankle fracture, the treating surgeon must always evaluate syndesmotic stability. If the syndesmosis is determined to be unstable, a reduction of the distal tibiofibular joint should be performed. Failure to adequately identify and treat injuries to the syndesmosis may result in continued ankle instability and poor patient outcomes. Lateral fluoroscopic images are necessary to assess a closed reduction of the syndesmosis before stabilization, although the accuracy of this tool has been questioned in several studies...
August 2016: Journal of Orthopaedic Trauma
S Jasqui-Remba, A Torres-Gómez, G A Salas-Morales, A Hernández-Martínez
The tibiofibular syndesmosis provides stability to the ankle mortise. The ankle syndesmosis is compromised in all Weber C type injuries. The radiographic method described by Merle DAubigné considers the bony relationships as a measure of syndesmotic widening. We sought to investigate whether the patients with a C type ankle fracture treated with ORIF and placement of a transyndesmal screw have an increment of the tibiofibular space and decrease of the tibiofibular overlap after the transyndesmal screw is removed...
November 2015: Acta Ortopédica Mexicana
Zackary A Johnson, Paul M Ryan, Claude D Anderson
Subtle syndesmotic instability not evident on radiography can result in chronic ankle pain. The diagnosis is uncommon, and arthroscopic evaluation remains the gold standard for diagnosis. Definitive surgical management can be performed at the time of diagnosis. Patients with 2 to 4 mm of diastasis of the syndesmosis or translation can be treated with debridement alone, and patients with 4 mm or more of diastasis or translation can be treated with arthroscopic debridement and reduction followed by percutaneous stabilization...
April 2016: Arthroscopy Techniques
Luis A Feigenbaum, Lee D Kaplan, Tony Musto, Ignacio A Gaunaurd, Robert S Gailey, William P Kelley, Timothy J Alemi, Braulio Espinosa, Eli Mandler, Vincent A Scavo, Dustin C West
BACKGROUND AND PURPOSE: Multiple rehabilitation factors including overall wellness need to be considered when an athlete returns to sport after an injury. The purpose of this case report is to describe a multidisciplinary approach for return to sport of a Division I collegiate football player following a traumatic ankle fracture requiring surgical repair. The assessment and treatment approach included the use of a performance-based physical therapy outcome measure, self-reported functional abilities, body composition assessments, and nutritional counseling...
June 2016: International Journal of Sports Physical Therapy
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