scholarly journals Diagnosis of tibiofibular syndesmosis instability in Weber type B malleolar fractures

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052093975
Author(s):  
Qiang Huang ◽  
Yongxing Cao ◽  
Chonglin Yang ◽  
Xingchen Li ◽  
Yangbo Xu ◽  
...  
Keyword(s):  
Ankle Fractures ◽  
Preoperative Imaging ◽  
Diagnostic Efficiency ◽  
Tibiofibular Syndesmosis ◽  
Type B ◽  
X Ray ◽  
Malleolar Fractures ◽  
Distal Tibiofibular Syndesmosis ◽  
Arthroscopic Findings ◽  
Weber Type

Objective This study was performed to analyze the clinical value of X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) examinations for the diagnosis of distal tibiofibular syndesmosis injuries in Weber type B ankle fractures with reference to the ankle arthroscopic findings. Methods This retrospective clinical study involved 52 patients with type B ankle fractures from August 2014 to January 2018. We analyzed the patients’ preoperative imaging data and judged the stability of the distal tibiofibular syndesmosis using X-ray, CT, and MRI examinations. We also evaluated the syndesmosis stability with arthroscopy both statically and dynamically. Results With the arthroscopic findings as the standard, the sensitivity of X-ray for diagnosing syndesmosis instability was 52.8%, the specificity was 100%, and the diagnostic efficiency was 67.3%. The sensitivity of CT for diagnosing syndesmosis instability was 77.8%, the specificity was 100%, and the diagnostic efficiency was 84.6%. The sensitivity of MRI for diagnosing syndesmosis instability was 100%, the specificity was 81.3%, and the diagnostic efficiency was 94.2%. Conclusion This study suggests that an arthroscopic examination may be recommended when the X-ray or CT features are different from the MRI findings while diagnosing tibiofibular syndesmosis instability in Weber type B malleolar fractures.

Surgical Treatment of Lateral Malleolar Fractures Using the Compression Cerclage System

2016 ◽  
Vol 106 (5) ◽  
pp. 313-318 ◽  
Author(s):  
Eren Cansü ◽  
Mehmet B. Unal ◽  
Serkan Gurcan ◽  
Fatih Parmaksizoglu
Keyword(s):  
Surgical Technique ◽  
Kirschner Wire ◽  
Ankle Fractures ◽  
Wound Complications ◽  
Lateral Side ◽  
Cerclage Wire ◽  
Malleolar Fractures ◽  
Trimalleolar Fractures ◽  
Weber Type

Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system. Methods The surgical technique consists of a Kirschner wire that is passed percutaneously and perpendicular to the fracture line, and a cerclage wire that is passed in a semi-circular fashion over the ends of the Kirschner wire on the lateral side of the bone, leaving loops on each side to allow bilateral compression while twisting both wires. We retrospectively evaluated patients treated with this technique, with or without additional fractures. Follow-up of <24 months and bilateral ankle fractures were the exclusion criteria. Fractures were examined clinically and radiologically in comparison to the uninjured side and were rated according to the criteria reported by McLennon and Ungersma. Olerud and Molander ankle score was used to evaluate functional outcome. Results At the final follow-up, 15 out of 21 patients (9 women and 6 men; mean age, 48.2 years [range, 19–78 years]) were evaluated. The mean follow-up was 5.16 years (28–129 months). Five patients had an isolated lateral malleolar fracture; eight had lateral and medial malleolar fractures; and two had trimalleolar fractures. At the final follow-up, 11 patients were rated good functionally and four were fair, and all patients were rated good radiographically according to the criteria by McLennon and Ungersma. Mean Olerud and Molander ankle score was 93.3 (range, 80–100). Conclusions The compression cerclage system provides good functional and radiological outcomes in patients with lateral malleolus fractures. This method is useful, safe, and efficient with minimum hardware. It can be applied through limited soft-tissue stripping, which is especially important in patients with a high risk for wound complications.

scholarly journals PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 43S
Author(s):  
Guilherme Honda Saito ◽  
Marcelo Pires Prado ◽  
Alberto Abussamra Moreira Mendes ◽  
Danilo Ryuko Nishikawa ◽  
Beatriz Devito ◽  
...  
Keyword(s):  
Hardware Removal ◽  
Ankle Fractures ◽  
Tibiofibular Syndesmosis ◽  
Aofas Score ◽  
Patient Functioning ◽  
Suture Button ◽  
Distal Tibiofibular Syndesmosis ◽  
Tibiofibular Joint ◽  
The Mean

Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.

The Value of Additional Gravity Stress Radiographs for Decision Making in the Treatment of Isolated Type B Distal Fibular Fractures

2021 ◽  
pp. 107110072110010
Author(s):  
Claar A. T. van Leeuwen ◽  
Roderick W. J. J. van Dorst ◽  
Pieta Krijnen ◽  
Inger B. Schipper ◽  
Jochem M. Hoogendoorn
Keyword(s):  
Operative Treatment ◽  
Ankle Fractures ◽  
Type B ◽  
Stress Radiographs ◽  
Clear Space ◽  
Group I ◽  
Patient Reported ◽  
Weber Type ◽  
Group Ii ◽  
Mortise View

Background: Prior to treatment decisions concerning isolated Weber type B ankle fractures, assessment of the stability of the ankle joint is mandatory. The gravity stress (GS) radiograph is a radiographic tool to determine stability. We hypothesized that this additional GS radiograph would lead to fewer operative treatments by applying the criterion of operative treatment when medial clear space (MCS) > superior clear space (SCS) + 2 mm on the GS radiograph, compared with the nonstressed mortise view criteria of advising operative treatment in case of MCS > SCS + 1 mm. Methods: This retrospective comparative cohort study analyzed 343 patients aged between 18 and 70 years with an isolated Weber type B ankle fracture diagnosed at the emergency department between January 2014 and December 2019. The cohort was divided into 2 groups based on whether an additional GS radiograph was performed. Group I consisted of 151 patients in whom a regular mortise and lateral radiograph were performed. Group II comprised 192 patients, with an additional GS radiograph. Primary outcome was type of treatment (conservative vs operative). Secondary outcomes were patient-reported functional outcomes and pain. Results: Baseline characteristics of both groups did not differ. In group I, surgery was performed in 60 patients (39.7%) compared with 108 patients (56.3%) in group II ( P = .002). In the operatively treated patients, the mean MCS on regular mortise view was significantly smaller in patients in whom an additional GS radiograph was performed compared to patients without an additional GS radiograph (4.1 mm vs 5.2 mm, P < .001). Mean Olerud-Molander Ankle Score and mean visual analog scale (VAS) for pain did not differ significantly between groups I and II. Conclusions: Contrary to what was hypothesized, the introduction of an additional gravity stress radiograph, by which operative treatment was indicated if the MCS was wider than the SCS + 2 mm, did not result in reduced operative treatment of Weber type B ankle fractures when operative treatment was indicated for MCS > SCS + 1 mm on non-gravity stress radiographs. Level of Evidence: Level III: retrospective comparative study.

scholarly journals THE FEATURES OF TIBIOFIBULAR INJURY IN PATENTS WITH ANKLE FRACTURES

2010 ◽  
Vol 16 (2) ◽  
pp. 22-26
Author(s):  
N. F. Fomin ◽  
A. G. Ovdenko ◽  
R. A. Nadjafov ◽  
A. N. Bogdanov
Keyword(s):  
Ankle Joint ◽  
Soft Tissues ◽  
Minimal Invasive ◽  
Ankle Fractures ◽  
Fracture Treatment ◽  
Tibiofibular Syndesmosis ◽  
Distal Tibiofibular Syndesmosis

The role of interposition of soft tissues into tibiofibular syndesmosis is analyzed as a cause of unsatisfactory outcomes in the ankle joint pronation fracture treatment. The study is based on clinical (452 patients) and experimental material (36 experiments) including unfixed anatomic objects. The elevator for minimal invasive operative elimination of interposition of stumps of distal tibiofibular syndesmosis anterior and posterior ligaments is developed and tested.

scholarly journals Clinical Significance of Ankle Arthroscopy in the Diagnosis of Type B Ankle Fracture Associated with the Distal Tibiofibular Syndesmosis Injury

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0035
Author(s):  
Huang Qiang ◽  
Xu Xiangyang
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
External Rotation ◽  
Ankle Arthroscopy ◽  
Tibiofibular Syndesmosis ◽  
Type B ◽  
Rotation Test ◽  
Distal Tibiofibular Syndesmosis ◽  
Syndesmosis Injury ◽  
Mri Diagnosis

Category: Arthroscopy, Trauma Introduction/Purpose: To investigate clinical significance of ankle arthroscopy in the diagnosis of type B ankle fracture associated with the distal tibiofibular syndesmosis injury. Methods: From February 2014 to December 2016, the authors diagnosed and treated 35 cases of type B ankle fractures. including 23 males and 12 females; with an average age of (43.05±12.480) years. Each patient underwent preoperative assessment: according to the patient’s clinical manifestations and imaging examination, and before the operation and after internal fixation of ankle fracture, the Cotton test and the external rotation test were done in the C arm X-ray, the initial diagnosis whether there is the distal tibiofibular syndesmosis injury. When the Cotton test and the external rotation test was used, Ankle arthroscopy was used to observe and evaluate whether there is the distal tibiofibular syndesmosis injury. For patients with the distal tibiofibular syndesmosis injury, In addition to the internal fixation of the ankle fracture, the TightRope was used to repair the injury. And observation of repair effect by ankle arthroscopy. Results: After internal fixation of ankle fracture, the Cotton test and the external rotation test was performed under the C arm X-ray, there were no the distal tibiofibular syndesmosis injury in 22 patients. Preoperative CT showed 6 cases of combined the distal tibiofibular syndesmosis injury, Preoperative MRI showed 13 cases of combined the distal tibiofibular syndesmosis injury. Ankle arthroscopy confirmed 11 cases of combined the distal tibiofibular syndesmosis injury. The sensitivity of ankle arthroscopy and MRI diagnosis combined with the distal tibiofibular syndesmosis injury was higher than that of CT sensitivity(P<0.05). The sensitivity of ankle arthroscopy for the diagnosis of the distal tibiofibular syndesmosis injury was weaker than that of MRI in the diagnosis of the distal tibiofibular syndesmosis injury (P<0.05). MRI diagnosis of the distal tibiofibular syndesmosis injury can be false positive. Conclusion: Ankle arthroscopy can directly observe the medial triangle ligament of the ankle, the distal tibiofibular syndesmosis injury, which provides the basis for correct diagnosis and treatment of Type B ankle fracture with the distal tibiofibular syndesmosis injury. And it can evaluate the stability of ankle after repairing the distal tibiofibular syndesmosis injury.

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