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.

scholarly journals Role of Arthroscopy in Ankle Fracture Surgery

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Jae Hoon Ahn
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
Postoperative Outcome ◽  
Persistent Pain ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Syndesmosis Injury ◽  
Poor Outcomes

The ankle arthroscopy is widely used as an essential tool for the various ankle disorders. The use of arthroscopy has also been tried for the treatment of acute ankle fractures, in the hope of improving the postoperative outcome. It was initially thought that the properly reduced ankle fractures had generally acceptable outcomes, with a reported rate of 81% good to excellent results. However further investigation and longer term follow-up has shown more mixed and less encouraging results. Some patients have persistent pain and poor outcomes following open reduction and internal fixation (ORIF), although the cause of poor outcome is not clearly understood. It may be secondary to intra-articular injuries at the time of fracture, which occur in up to 88% of fractures. Ankle arthroscopy at the time of ORIF has been proposed to address these intraarticular injuries. Arthroscopy-assisted reduction and percutaneous screw fixation for syndesmosis injury has been performed as well by some surgeons. However the effectiveness of true arthroscopic reduction and internal fixation compared with ORIF for ankle fractures has yet to be determined, in spite of the advantages such as limited exposure, preservation of blood supply, and improved visualization of the pathology. Postoperative chronic pain and arthrofibrosis after ankle fracture are another good indication for ankle arthroscopy, which can be performed at the time of implant removal. In conclusion, the ankle arthroscopy is a safe adjunctive procedure for the treatment of ankle fractures. It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures.

scholarly journals Distal Tibiofibular Syndesmosis: Anatomy, Biomechanics, Injury and Management

2017 ◽  
Vol 11 (1) ◽  
pp. 670-677 ◽  
Author(s):  
Chi Pan Yuen ◽  
Tun Hing Lui
Keyword(s):  
External Rotation ◽  
Syndesmotic Injury ◽  
Tibiofibular Syndesmosis ◽  
Stress Tests ◽  
Arthroscopic Technique ◽  
Joint Injury ◽  
Major Mechanism ◽  
Distal Tibiofibular Syndesmosis ◽  
Bony Avulsion ◽  
Syndesmosis Injury

A stable and precise articulation of the distal tibiofibular syndesmosis is essential for normal motion of the ankle joint. Injury to the syndesmosis occurs through rupture or bony avulsion of the syndesmotic ligament complex. External rotation of the talus has been identified as the major mechanism of syndesmotic injury. None of the syndesmotic stress tests was sensitive or specific; therefore the diagnosis of syndesmotic injury should not be made based on the medical history and physical examination alone. With the improvement in ankle arthroscopic technique, it can be used as a diagnostic and therapeutic tool in the management of distal tibiofibular syndesmosis injury.

A novel method of using elastic bionic fixation device for distal tibiofibular syndesmosis injury

2018 ◽  
Vol 42 (9) ◽  
pp. 2219-2229 ◽  
Author(s):  
Lin Wang ◽  
Yingze Zhang ◽  
Zhaohui Song ◽  
Hengrui Chang ◽  
Ye Tian ◽  
...  
Keyword(s):  
Tibiofibular Syndesmosis ◽  
Fixation Device ◽  
Distal Tibiofibular Syndesmosis ◽  
Syndesmosis Injury ◽  
Novel Method

Impact of Torque on Assessment of Syndesmotic Injuries Using Weightbearing Computed Tomography Scans

2019 ◽  
Vol 40 (6) ◽  
pp. 710-719 ◽  
Author(s):  
Nicola Krähenbühl ◽  
Travis L. Bailey ◽  
Maxwell W. Weinberg ◽  
Nathan P. Davidson ◽  
Beat Hintermann ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Axial Load ◽  
External Rotation ◽  
Ct Scans ◽  
Deltoid Ligament ◽  
Tibiofibular Syndesmosis ◽  
Tibiofibular Ligament ◽  
Distal Tibiofibular Syndesmosis ◽  
Axial Ct ◽  
The Impact

Background: The diagnosis of subtle injuries to the distal tibiofibular syndesmosis remains elusive. Conventional radiographs miss a large subset of injuries that present without frank diastasis. This study evaluated the impact of torque application on the assessment of syndesmotic injuries when using weightbearing computed tomography (CT) scans. Methods: Seven pairs of male cadavers (tibia plateau to toe-tip) were included. CT scans with axial load application (85 kg) and with (10 Nm) or without torque to the tibia (corresponding to external rotation of the foot and ankle) were taken during 4 test conditions. First, intact ankles (native) were scanned. Second, 1 specimen from each pair underwent anterior inferior tibiofibular ligament (AITFL) transection (condition 1A), while the contralateral underwent deltoid transection (condition 1B). Third, the lesions were reversed on the same specimens and the remaining intact deltoid or AITFL was transected (condition 2). Finally, the distal tibiofibular interosseous membrane (IOM) was transected in all ankles (condition 3). Measurements were performed to assess the integrity of the distal tibiofibular syndesmosis on digitally reconstructed radiographs (DRRs) and on axial CT scans. Results: Torque impacted DRR and axial CT scan measurements in almost all conditions. The ability to diagnose syndesmotic injuries using axial CT measurements improved when torque was applied. No significant syndesmotic morphological change was observed with or without torque for either isolated AITFL or deltoid ligament transection. Discussion: Torque application had a notable impact on two-dimensional (2-D) measurements used to diagnose syndesmotic injuries for both DRRs and axial CT scans. Because weightbearing conditions allow for standardized positioning of the foot while radiographs or CT scans are taken, the combination of axial load and torque application may be desirable. Clinical Relevance: Application of torque to the tibia impacts 2-D measurements and may be useful when diagnosing syndesmotic injuries by DRRs or axial CT images.

scholarly journals Technical aspects of the syndesmotic screw and their effect on functional outcome following acute distal tibiofibular syndesmosis injury

Injury ◽  
2014 ◽  
Vol 45 (4) ◽  
pp. 775-779 ◽  
Author(s):  
Tim Schepers ◽  
Hans van der Linden ◽  
Esther M.M. van Lieshout ◽  
Dieu-Donné Niesten ◽  
Maarten van der Elst
Keyword(s):  
Functional Outcome ◽  
Tibiofibular Syndesmosis ◽  
Technical Aspects ◽  
Syndesmotic Screw ◽  
Distal Tibiofibular Syndesmosis ◽  
Syndesmosis Injury

scholarly journals The Predictive Value of MRI for Syndesmotic Instability of Ankle Fracture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Young Hwan Park ◽  
Hak-Jun Kim
Keyword(s):  
Predictive Value ◽  
Ankle Fracture ◽  
External Rotation ◽  
Stress Test ◽  
Preoperative Imaging ◽  
Mri Findings ◽  
Complete Tear ◽  
Syndesmosis Injury ◽  
Study Results ◽  
Type Fracture

Category: Ankle, Trauma Introduction/Purpose: Although many ankle fractures are combined with syndesmosis injury, preoperative imaging studies rarely reveal instability of the syndesmosis. This study assessed the use of magnetic resonance imaging (MRI) for syndesmotic instability in patients who have an unstable ankle fracture. Methods: A total of 74 patients who were treated for Lauge-Hansen supination external rotation, Weber B type fracture or pronation external rotation, Weber C type fracture and who underwent MRI before surgery to evaluate syndesmosis injury were enrolled. The MRI findings of the syndesmotic ligament and the results of an intraoperative stress test were assessed. Results: Twenty-six patients had a positive result on the intraoperative stress test. Regarding the MRI findings of the syndesmotic ligaments, complete tear of the posterior inferior tibiofibular ligament (PITFL) was the most reliable predictor of syndesmotic instability (sensitivity, 0.62; specificity, 0.94; positive predictive value, 0.84). Interobserver agreements for the intraoperative stress test and MRI assessment were excellent, except for the MRI findings of the interosseous ligament (62% agreement; kappa, 0.3). Conclusion: On the basis of the study results, complete tear of the PITFL on MRI has additional diagnostic value for syndesmotic instability in ankle fracture.

MRI Findings Associated with Distal Tibiofibular Syndesmosis Injury

2004 ◽  
Vol 182 (1) ◽  
pp. 131-136 ◽  
Author(s):  
Kevin W. Brown ◽  
William B. Morrison ◽  
Mark E. Schweitzer ◽  
J. Antoni Parellada ◽  
Henry Nothnagel
Keyword(s):  
Tibiofibular Syndesmosis ◽  
Mri Findings ◽  
Distal Tibiofibular Syndesmosis ◽  
Syndesmosis Injury
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