scholarly journals Four-Dimensional CT Analysis of Normal Syndesmotic Motion

2021 ◽  
pp. 107110072110152
Author(s):  
Murray T. Wong ◽  
Charmaine Wiens ◽  
Jeremy Lamothe ◽  
W. Brent Edwards ◽  
Prism S. Schneider
Keyword(s):  
Functional Outcomes ◽  
Sagittal Plane ◽  
Syndesmotic Injury ◽  
Level Of Evidence ◽  
Level Ii ◽  
Anatomic Reduction ◽  
Tibiofibular Joint ◽  
Ct Analysis ◽  
Within Subjects

Background: The syndesmosis ligament complex stabilizes the distal tibiofibular joint while allowing for small amounts of physiologic motion. When injured, malreduction of the syndesmosis is the most important factor that contributes to inferior functional outcomes. Syndesmotic reduction is a dynamic measure, which is not adequately captured by conventional computed tomography (CT). Four-dimensional CT (4DCT) can image joints as they move through range of motion (ROM). The aim of this study was to employ 4DCT to determine in vivo syndesmotic motion with ankle ROM in uninjured ankles. Methods: Uninjured ankles were analyzed in patients who had contralateral syndesmotic injuries, as well as a cohort of healthy volunteers with bilateral uninjured ankles. Bilateral ankle 4DCT scans were performed as participants moved their ankles between maximal dorsiflexion and plantarflexion. Multiple measures of syndesmotic width, as well as sagittal translation and fibular rotation, were automatically extracted from 4DCT using a custom program to determine the change in syndesmotic position with ankle ROM. Results: Fifty-eight ankles were analyzed. Measures of syndesmotic width decreased by 0.7 to 1.1 mm as the ankle moved from dorsiflexion to plantarflexion ( P < .001 for each measure). The fibula externally rotated by 1.2 degrees with ankle ROM ( P < .001), but there was no significant motion in the sagittal plane ( P = .43). No participants with bilateral uninjured ankles had a side-to-side difference in syndesmotic width of 2 mm or greater. Conclusion: 4DCT allows accurate, in vivo syndesmotic measurements, which change with ankle ROM, confirming prior work that was limited to biomechanical studies. Side-to-side syndesmotic measurements are consistent within subjects, validating the method of templating syndesmotic reduction off the contralateral ankle, in a consistent ankle position, to achieve anatomic reduction of syndesmotic injury. Level of Evidence: Level II.

Radiographic Change of the Distal Tibiofibular Joint Following Removal of Transfixing Screw Fixation

2017 ◽  
Vol 39 (3) ◽  
pp. 318-325 ◽  
Author(s):  
Jong Hun Baek ◽  
Tae Yong Kim ◽  
Yoo Beom Kwon ◽  
Bi O Jeong
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Plain Radiographs ◽  
Spontaneous Reduction ◽  
Level Ii ◽  
Anatomic Reduction ◽  
Significant Difference ◽  
Tibiofibular Joint ◽  
Axial Ct

Background: Syndesmosis disruptions in the ankle joint are typically treated with anatomic reduction followed by transfixing screw and/or suture button fixation. The purpose of our study was to analyze the effects of the removal of transfixing screws on syndesmosis integrity using plain radiographs and computed tomography (CT) scans. Methods: Twenty-nine cases (29 patients) who had been treated with transfixing screw fixation for syndesmosis disruptions were studied prospectively. Plain radiographs and CT scans were obtained 1 day before and 3 months after the removal of transfixing screws. The tibiofibular clear space (TCS) and tibiofibular overlap (TFO) were measured on plain radiographs, and the anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT scans to radiographically analyze the effect of the removal of screws on syndesmosis integrity. Results: On plain radiographs, syndesmosis diastasis was not observed before or after the removal of transfixing screws. No statistically significant difference was found in the TCS and the TFO between measurements at prescrew removal and at postscrew removal ( P = .761 and .628, respectively). However, the syndesmosis was found malreduced on CT scans in 7 cases (24.1%) before screw removal. All 7 cases showed anterior malreduction of the syndesmosis, 5 (71.4%) of which spontaneously reduced after screw removal. The A/P ratio of the 7 cases decreased from a mean of 1.37 (range, 1.26-1.61) at prescrew removal to a mean of 1.12 (range, 0.96-1.25) at postscrew removal ( P = .016). Conclusion: Syndesmosis malreduction not observed on plain radiographs after performing transfixing screw fixation was identified with CT scans. Of the cases with a malreduced syndesmosis, 71.4% showed spontaneous reduction after screw removal. Therefore, we believe the removal of transfixing screws is recommended after confirming malreduction on CT scans, although plain radiographs demonstrate anatomic reduction. Level of Evidence: Level II, prospective prognostic study.

scholarly journals The Radiologic Change of Distal Tibiofibular Joint Following the Removal of the Transfixing Screw After Syndesmotic Injury

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Bi O Jeong ◽  
Jong Hun Baek ◽  
Wookjae Song
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Syndesmotic Injury ◽  
Anatomic Reduction ◽  
Syndesmosis Injury ◽  
Before And After ◽  
Tibiofibular Joint ◽  
Ankle Trauma ◽  
Axial Ct ◽  
Male Patients

Category: Ankle, Trauma Introduction/Purpose: Transfixing screw fixation is required after anatomic reduction of syndesmosis disruption. An accurate anatomic reduction is related to good functional outcome. However, there is a dispute over whether the transfixing screw should be removed, and little is known about the change of syndesmosis integrity after screw removal. This study aimed to evaluate the effect of transfixing screw removal on syndesmosis integrity with computed tomography (CT) scans. Methods: The study was done prospectively on 28 cases (28 patients) who had transfixing screw fixation for syndesmosis injury from September 2010 to August 2016. Mean age was 31.9 years (range, 17 to 55 years). There were 20 male patients and 8 female patients. Transfixing screws were removed after 3 months, and CT scans were done just before and 3 months after transfixing screw removal. Anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT images for radiological analysis of changes in syndesmosis integrity between before and after screw removal. Results: Malreduction was observed in 7 cases (25%) before transfixing screw removal. All 7 cases were anterior malreductions. Syndesmosis was spontaneously reduced after screw removal in 5 out of the 7 malreduction cases (71.4%). The A/P ratio in the 7 cases decreased from average 1.37 (range, 1.25 to 1.61) before screw removal to average 1.12 (range, 0.96 to 1.25) after screw removal. The decrease was statistically significant (p = 0.016). Syndesmosis malreduction rate decreased from 25% before screw removal to 7.1% after screw removal. All patients with adequate reduction of their syndesmosis continued to have a reduced syndesmosis after transfixing screw removal. However, this difference in malreduction rate was statistically insignificant (p=0.063). Conclusion: Although the malreduction rate is relatively high after transfixing screw fixation in disrupted syndesmosis, the malreduced syndesmosis was spontaneously reduced in 71% of cases after screw removal. Therefore, it is beneficial to remove the transfixing screw a certain period of time after transfixing screw fixation to achieve anatomic reduction of the syndesmosis.

Relationships Between Radiographic Pre- and Postoperative Alignment and Patient Perceived Outcomes Following Weber B and C Ankle Fractures

2016 ◽  
Vol 38 (3) ◽  
pp. 270-276 ◽  
Author(s):  
Erik Hohmann ◽  
Frith Foottit ◽  
Kevin Tetsworth
Keyword(s):  
Functional Outcomes ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Level Of Evidence ◽  
Significant Relationships ◽  
Younger Age ◽  
Anatomic Reduction ◽  
Weber Type ◽  
Standard Radiographs ◽  
Perceived Outcomes

Background: Anatomic reduction of ankle fractures may influence outcomes but the relationships between these 2 variables are still unknown and require further investigation. The purpose of this study was to investigate the relationships between radiologic alignment of surgically treated ankle fractures and functional outcomes. Methods: This retrospective study included patients who were surgically treated for Weber B and C ankle fractures. The outcome measures consisted of the Olerud and Molander Ankle Score (OMAS) and the foot and ankle disability measure. Standard radiographs included anteroposterior, lateral, and mortise views of the ankle, both on pre- and postoperatively. Between June 2011 and December 2013, a total of 152 patients were treated for ankle fractures and 76 patients with a mean age of 41.3 ± 17.1 years and a mean follow-up of 39.6 ± 8.9 months were included. There were 45 Weber type B fractures (mean age 43.4 ± 17.8, 28 females, 17 males) and 31 Weber type C fractures (mean age 40.7 ± 17.3, 12 females, 19 males). Results: Linear regression did not reveal any significant relationships with the exception of age. There was a moderate correlation between the OMAS outcome score and age ( r2 = 0.46, P = .01). Conclusion: We found that younger age was a moderate predictor of functional outcome following surgical treatment of ankle fractures. Radiographic alignment using standard non-weight-bearing radiographs and fracture severity did not predict functional outcomes at 24 months postoperatively. Level of Evidence: Level III, prognostic, retrospective cohort study.

scholarly journals Functional outcomes of unstable ankle fractures with and without syndesmotic fixation in the adolescent population

2021 ◽  
pp. 1-8
Author(s):  
Conner J. Paez ◽  
Benjamin M. Lurie ◽  
Vidyadhar V. Upasani ◽  
Andrew T. Pennock
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Syndesmotic Injury ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Male Sex

Purpose: The purpose of this study was to compare functional outcomes of adolescents with and without ankle syndesmotic injuries and identify predictors of functional outcome after operative ankle fractures. Methods: A retrospective review was conducted on operative adolescent ankle fractures treated between 2009 and 2019 with a minimum of one-year follow-up (mean 4.35 years). Patients who underwent syndesmotic fixation (SF) (n = 48) were compared with operative ankle fractures without syndesmotic injury (n = 63). Functional outcomes were assessed using standardized questionnaires, specifically the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numerical Evaluation. Results: There were no differences in patient-reported outcomes, rates of return to sport or complications between groups with and without SF. The SF group had a longer tourniquet time (p = 0.04), duration of non-weight-bearing (p = 0.01), more Weber C fibula fractures (p < 0.001), fewer medial malleolus fractures (p = 0.03) and more frequently underwent implant removal (p < 0.0001). Male sex, lower body mass index (BMI) and longer duration of follow-up were significant predictors of a higher FAAM sports score using multivariable linear regression. SF was not a predictor of functional outcome. Conclusion: This study demonstrated that patients that undergo surgical fixation of syndesmotic injuries have equivalent functional outcomes compared to operative ankle fractures without intraoperative evidence of syndesmotic injury. We also identified that male sex, lower BMI and longer duration of follow-up are predictors of a good functional outcome. Level of Evidence: III

In Vivo CT Analysis of Physiological Fibular Motion at the Level of the Ankle Syndesmosis During Plantigrade Weightbearing

2018 ◽  
Vol 12 (3) ◽  
pp. 233-237 ◽  
Author(s):  
Paul Hoogervorst ◽  
Zachary M. Working ◽  
Ashraf N. El Naga ◽  
Meir Marmor
Keyword(s):  
Imaging System ◽  
Statistical Significance ◽  
Ct Images ◽  
Computed Tomographic ◽  
Anteroposterior Translation ◽  
Tibiofibular Joint ◽  
Ct Evaluation ◽  
Ct Analysis ◽  
Axial Ct

Background. It is clear that motion at the syndesmosis occurs due to ranging of the ankle joint, but the influence of weightbearing with the foot in the plantigrade position is unclear. In vivo computed tomographic (CT) evaluation of the syndesmosis has not been previously described. The purpose of this study is to quantify physiological fibular motion at the level of the ankle syndesmosis in both weightbearing and nonweightbearing conditions with the foot in the plantigrade position. Methods. CT images were obtained from 9 normal healthy subjects using a weightbearing CT imaging system. The subjects were positioned in a nonweightbearing and weightbearing state with their foot in the plantigrade position. Fibular translation and rotation were measured from the axial CT images using previously validated techniques. Results. Both the average lateral and anteroposterior translation of the fibula between weightbearing and nonweightbearing states was minimal (0.3 mm and 0.2 mm, respectively). The largest difference in translation observed in either direction was 0.9 mm. An average of 0.5° was found for rotational differences of the fibula between weightbearing and nonweightbearing. Neither of the translational and rotational parameters reached statistical significance. Conclusion. In vivo CT analysis of the distal tibiofibular joint with an intact syndesmosis did not reveal statistically significant physiological motion between weightbearing and nonweightbearing conditions with the foot in plantigrade position. Our findings suggest that weightbearing accounts for little motion at the syndesmosis and supports further investigation into the role of early protected weightbearing after syndesmosis fixation. Levels of Evidence: Level III: Case-control study

Arthroscopic Evaluation of Syndesmotic Instability and Malreduction

2016 ◽  
Vol 9 (6) ◽  
pp. 500-505 ◽  
Author(s):  
Douglas E. Lucas ◽  
B. Collier Watson ◽  
G. Alex Simpson ◽  
Gregory C. Berlet ◽  
Christopher F. Hyer
Keyword(s):  
Sagittal Plane ◽  
Ankle Arthroscopy ◽  
Syndesmotic Injury ◽  
Tibiofibular Syndesmosis ◽  
Therapeutic Level ◽  
Anatomic Reduction ◽  
Highly Sensitive ◽  
Complete Disruption ◽  
Plane Displacement ◽  
Anatomic Alignment

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. Ten transtibial amputation cadavers were utilized for this study. Two distinct analyses were undertaken. The first, analysis of instability, utilized 2 dissection groups, a superficial dissection only and a partial disruption instability model. The second analysis was of syndesmotic malreduction. For this, all 10 specimens underwent complete disruption of the syndesmosis and subsequent fixation in either anatomic alignment or malreduction. Both analyses were performed by surgeons blinded to the condition of the syndesmosis. Two groups of surgeons were able to identify syndesmotic instability a combined 75% of the time. Malreduction diagnosis was mixed with a 100% accurate diagnosis of sagittal plane displacement but only 50% accuracy for rotation and 17% for an anatomic reduction. Syndesmotic injury during ankle fracture presents a significant problem to the treating surgeon. Ankle arthroscopy has been shown in the literature to be highly sensitive for diagnosing instability but has not been evaluated in diagnosing malreduction. The current study shows moderate success in diagnosing both malreduction and instability. Levels of Evidence: Therapeutic, Level V: Basic Science

A Prospective Cohort Study Comparing Functional Outcomes of Primary and Revision Ankle Replacements

2021 ◽  
pp. 107110072110101
Author(s):  
Toby Jennison ◽  
Andrew King ◽  
Christopher Hutton ◽  
Ian Sharpe
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Functional Outcomes ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Level Ii ◽  
The Social ◽  
Functional Scores ◽  
Small Cohort

Background: The number of ankle and revision ankle replacements performed is increasing. There is limited research into functional outcomes, especially in revision ankle replacements. The primary aim of this cohort study was to determine the functional improvements following primary and revision ankle replacements and compare which gave the greatest improvement in functional scores. Methods: A single-center prospective cohort study was undertaken between 2015 and 2018. All patients were followed up for a minimum of 2 years. Patients undertook a preoperative and 2-year Manchester Oxford Foot Questionnaire (MoxFQ) score. The Mann Whitney test was undertaken. Results: A total of 33 primary and 23 revision ankle replacements were performed between 2015 and 2018. The mean age was 69.3 years for primary replacements and 64.7 years for revision replacements. All primary replacements were the Infinity ankle replacement. Revision replacements were either the Inbone II or Invision. The indication for revision was 9 aseptic loosening, 6 infections, 5 cysts, and 3 malposition. Seventeen were performed as a single stage and 6 as a 2-stage revision. The overall MoxFQ improved by a mean of 48.8 for primaries and 20.2 for revisions ( P = .024). The walking/standing domain improved by 57.5 for primaries and 22.5 for revisions ( P = .016), the pain score improved by 43.0 and 32.3 ( P = .009), and the social interaction improved by 40.0 and 11.7 ( P = .128). Conclusion: Both primary and revision ankle replacements result in improved functional scores. In this relatively small cohort with the implants used, primary ankle replacements though have a significantly greater improvement in functional scores compared to revision ankle replacements. Level of Evidence: Level II, prospective cohort study.

Factors Predicting the Outcome After Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Dislocations

2019 ◽  
Vol 47 (11) ◽  
pp. 2670-2677 ◽  
Author(s):  
Nina Maziak ◽  
Laurent Audige ◽  
Carmen Hann ◽  
Marvin Minkus ◽  
Markus Scheibel
Keyword(s):  
Clinical Outcome ◽  
Acromioclavicular Joint ◽  
High Grade ◽  
Radiological Outcome ◽  
Ac Joint ◽  
Level Of Evidence ◽  
Outcome Parameters ◽  
Joint Dislocations ◽  
Anatomic Reduction ◽  
Arthroscopically Assisted

Background: Factors influencing the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular (AC) joint dislocations remain poorly investigated. Purpose: To identify determinants of the radiological outcome and investigate associations between radiological and clinical outcome parameters. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective analysis of patients who underwent arthroscopically assisted stabilization for acute high-grade AC joint dislocations. The following potential determinants of the radiological outcome were examined using univariable and multivariable regression analyses: timing of surgery, initial AC joint reduction, isolated coracoclavicular (CC) versus combined CC and AC stabilization, ossification of the CC ligaments, age, and overweight status. In addition, associations between radiological (ie, CC difference, dynamic posterior translation [DPT]) and clinical outcome parameters (Subjective Shoulder Value, Taft score [TS] subjective subcategory, and Acromioclavicular Joint Instability Score [ACJI] pain subitem) were evaluated using univariable analysis. Results: One hundred four patients with a mean (±SD) age of 38.1 ± 11.5 years were included in this study. The mean postoperative follow-up was 2.2 ± 0.9 years. Compared with patients with an overreduced AC joint after surgery, the CC difference was 4.3 mm (95% CI, 1.3-7.3; P = .006) higher in patients with incomplete reduction. Patients with anatomic reduction were 3.1 times (95% CI, 1.2-7.9; P = .017) more likely to develop DPT than those with an overreduced AC joint. An incompletely reduced AC joint was 5.3 times (95% CI, 2.1-13.4; P < .001) more likely to develop DPT versus an overreduced AC joint. Patients who underwent isolated CC stabilization were 4.8 times (95% CI, 1.1-21.0; P = .039) more likely to develop complete DPT than patients with additional AC stabilization. Significantly higher CC difference values were noted for patients who reported pain on the subjective TS ( P = .025). Pain was encountered more commonly in patients with DPT ( PTS = .049; PACJI = .038). Conclusion: Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. Because of its association with superior radiographic outcomes, consideration should also be given to the use of additional AC cerclage.

Design, Fabrication, and Accuracy of a Novel Noncovering Lock-Mechanism Bilateral Patient-Specific Drill Guide Template for Nondeformed and Deformed Thoracic Spines

2021 ◽  
pp. 155633162199633
Author(s):  
Mehran Ashouri-Sanjani ◽  
Shima Mohammadi-Moghadam ◽  
Parisa Azimi ◽  
Navid Arjmand
Keyword(s):  
Thoracic Spine ◽  
Sagittal Plane ◽  
Ct Scanning ◽  
Entry Point ◽  
In Vivo Studies ◽  
Patient Specific ◽  
Plane Angle ◽  
Severe Scoliosis ◽  
3D Printed

Background: Pedicle screw (PS) placement has been widely used in fusion surgeries on the thoracic spine. Achieving cost-effective yet accurate placements through nonradiation techniques remains challenging. Questions/Purposes: Novel noncovering lock-mechanism bilateral vertebra-specific drill guides for PS placement were designed/fabricated, and their accuracy for both nondeformed and deformed thoracic spines was tested. Methods: One nondeformed and 1 severe scoliosis human thoracic spine underwent computed tomographic (CT) scanning, and 2 identical proportions of each were 3-dimensional (3D) printed. Pedicle-specific optimal (no perforation) drilling trajectories were determined on the CT images based on the entry point/orientation/diameter/length of each PS. Vertebra-specific templates were designed and 3D printed, assuring minimal yet firm contacts with the vertebrae through a noncovering lock mechanism. One model of each patient was drilled using the freehand and one using the template guides (96 pedicle drillings). Postoperative CT scans from the models with the inserted PSs were obtained and superimposed on the preoperative planned models to evaluate deviations of the PSs. Results: All templates fitted their corresponding vertebra during the simulated operations. As compared with the freehand approach, PS placement deviations from their preplanned positions were significantly reduced: for the nonscoliosis model, from 2.4 to 0.9 mm for the entry point, 5.0° to 3.3° for the transverse plane angle, 7.1° to 2.2° for the sagittal plane angle, and 8.5° to 4.1° for the 3D angle, improving the success rate from 71.7% to 93.5%. Conclusions: These guides are valuable, as the accurate PS trajectory could be customized preoperatively to match the patients’ unique anatomy. In vivo studies will be required to validate this approach.

scholarly journals Hydroxyapatite-incorporation improves bone formation on endosseous PEEK implant in canine tibia

2020 ◽  
Vol 18 ◽  
pp. 228080002097517
Author(s):  
Yuan-ming Geng ◽  
Dong-ni Ren ◽  
Shu-yi Li ◽  
Zong-yi Li ◽  
Xiao-qing Shen ◽  
...  
Keyword(s):  
Bone Formation ◽  
Dental Implants ◽  
Low Cost ◽  
Low Elastic Modulus ◽  
Ether Ether Ketone ◽  
Poly Ether Ether Ketone ◽  
Alternative Material ◽  
Ct Analysis ◽  
Potential Alternative

Background: Poly Ether Ether Ketone (PEEK) has been considered as a potential alternative material for endosseous dental implants, for its low elastic modulus, biocompatibility, and low cost in customized device manufacture. Hydroxyapatite-incorporation is supposed to improve the poor osseointegration of PEEK. Methods: In the present study we analyzed the in vivo response of hydroxyapatite-incorporated PEEK (PEEK-HA) implants in canine tibia. PEEK-HA and PEEK implants were implanted and were examined 4 weeks and 12 weeks after implantation with radiology and histology. Commercial titanium dental implants served as controls. Results: The ratio of bone volume to tissue volume of PEEK-HA implants was higher than that of PEEK implants 4 weeks after implantation in the μ-CT analysis. The bone implant contact of PEEK and PEEK-HA implants showed no statistical difference in the histological examination, but newly-formed bone around PEEK-HA implants showed more signs of mineralization than that around PEEK implants. Conclusion: The study suggested that bone formation was improved with hydroxyapatite-incorporation in PEEK. Hydroxyapatite-incorporated PEEK implants may represent a potential material for endosseous dental implant.

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