Efficacy of the Glidepath Technique for Ankle Syndesmosis Reduction

Category: Ankle; Trauma Introduction/Purpose: Syndesmotic screw fixation is frequently required in rotational ankle injuries. Fibular malreduction after syndesmotic screw fixation occurs in as many as 52% of cases, which has been shown to detrimentally affect subjective outcomes and increase the probability of developing arthritis. The glidepath technique has been proposed as a useful technique to prevent malreduction. We hypothesize that the glidepath technique reduces the occurrence of fibular malreduction and results in improved outcomes compared to clamping. Methods: A retrospective cohort study comparing 25 patients reduced with a clamp compared to 18 patient using the glidepath technique. The glidepath technique, described by Needleman, the fibula is manually reduced and a Kirschner wire is placed through the fibula and tibia along the transmalleolar axis, parallel to the superior border of the ankle mortise. CT scans of the injured and contralateral ankles were obtained postoperatively to assess reduction. Malreduction is defined as >2mm difference between the anterior or posterior incisura-fibular distance of the injured ankle compared to the contralateral side. Prospective outcomes were assessed using the AOFAS and VR-12 scores at preoperative, 3 month, 6 month and 1 year followup of the glidepath cohort only. Results: We found a statistically significant reduction in malreduced syndesmoses using the glidepath technique when compared with the clamping technique. In our study, 17% (3/18) were malreduced using the glidepath technique, compared with 48% (12/25 patients) with clamping (p=0.005). The three malreductions seen in our study were anterior, we had no posterior malreductions. Compared with the clamping cohort that had 10/25 posterior malreductions and 2/25 anterior malreductions. Mean outcomes at 3,6 and 1 year scores were AOFAS 76, 86,86; VR-12 46,53,50/ 42,44,47 (physical/mental) respectively. Conclusion: Historically, malreduction for syndesmotic fixation is as high as 52%. The glidepath technique is a viable reduction maneuver that has lower rates of malreduction compared to clamping in our study. This is the first ever CT confirmed study measuring syndesmosis reduction utilizing manual reduction. The value of this technique is that is does not require an open reduction, arthroscopic visualization/reduction or CT guidance to achieve syndesmotic reduction.

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Syndesmotic screw fixation in Weber C ankle injuries–should the screw be removed before weight bearing?

Injury ◽

10.1016/j.injury.2006.02.003 ◽

2006 ◽

Vol 37 (9) ◽

pp. 891-898 ◽

Cited By ~ 75

Author(s):

David Paul Bell ◽

Merng Koon Wong

Keyword(s):

Screw Fixation ◽

Weight Bearing ◽

Ankle Injuries ◽

Syndesmotic Screw

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Overtightening of the Syndesmosis Revisited and the Effect of Syndesmotic Malreduction on Ankle Dorsiflexion

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000179 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Mohammad Ghorbanhoseini ◽

John Y. Kwon ◽

Tyler Gonzalez ◽

Brian Velasco ◽

Aron Lechtig ◽

...

Keyword(s):

Screw Fixation ◽

Statistical Significance ◽

Ankle Dorsiflexion ◽

P Value ◽

Posterior Displacement ◽

Syndesmotic Screw ◽

Anatomic Reduction ◽

Micro Sensor ◽

Ankle Trauma ◽

One Way Anova

Category: Ankle, Trauma Introduction/Purpose: Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: To assess the effect of syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of ankle dorsiflexion. To assess the effect of anterior & posterior syndesmotic malreduction after syndesmotic screw fixation on ankle dorsiflexion. Methods: Fifteen cadaveric leg specimens were utilized for the study. Ankle dorsiflexion was measured utilizing a precise micro- sensor system after application of a consistent load in the intact state, after compression fixation with a syndesmotic screw and after anterior & posterior malreduction of the syndesmosis. Results: Following screw compression of the nondisplaced syndesmosis, dorsiflexion ROM was 99.7±0.87% (mean ± standard error) of baseline ankle ROM. Anterior and posterior displacement of the syndesmosis resulted in dorsiflexion ROM that was 99.1±1.75% and 98.6±1.56% of baseline ankle ROM, respectively. One-way ANOVA was performed showing no statistical significance between groups (p-value =0.88). Two-way ANOVA comparing the groups with respect to both the reduction condition (intact, anatomic reduction, anterior displacement, posterior displacement) and the displacement order (anterior first, posterior first) did not demonstrate a statistically significant effect (p-value= 0.99). Conclusion: Maximal dorsiflexion of the ankle is not required prior to syndesmotic fixation. Anterior or posterior syndesmotic malreduction following syndesmotic screw fixation has no effect on ankle dorsiflexion thus poor patient outcomes after syndesmotic malreduction does not appear to be the result of loss of dorsiflexion due to mechanical block.

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Kirschner Wire as a Reference Marker for the Positioning of a Syndesmotic Screw: a Radiological Study and Clinical Application

10.21203/rs.3.rs-232615/v1 ◽

2021 ◽

Author(s):

Congming Zhang ◽

Qian Wang ◽

Ning Duan ◽

Teng Ma ◽

Kun Zhang ◽

...

Keyword(s):

Conventional Method ◽

Screw Fixation ◽

Kirschner Wire ◽

New Technique ◽

Ideal Space ◽

Syndesmotic Screw ◽

Number Of Patients ◽

Anatomic Axis ◽

Foot Fractures ◽

Very High

Abstract Background: Without a reliable and static reference, the rate of eccentrically positioned distal syndesmotic screw is very high. This article describes an additional method to improve surgeons’ ability to ideally place this screw. The purposes of our study were (1) to determine if an ideal space at 2.5 cm proximal to the plafond existed between the tibia and fibula for the placement of a Kirschner (K) wire and (2) to detect if it could act as a reliable and static fibular incisura plane reference. Methods: Computed tomography (CT) scans of 42 uninjured adult ankles with foot fractures were analysed to measure the tibiofibular vertical distance (TFVD) at 2.5 cm proximal to the plafond on transverse images. TFVD was defined as the distance between two lines: Line 1 was tangent to the fibular incisura, and Line 2 was parallel to Line 1 along the medial fibula. Patients were divided into four groups according to our TFVD data: 0–1, 1–2, 2–3, and 3–4 mm, and the number of patients in each group was counted. We assessed 23 patients who underwent syndesmotic screw fixation for ankle fractures. Comparison of the angle between the anatomic axis of the syndesmosis and screw axis (AAS) was performed between patients using conventional method (11 patients) and with K-wire marker (12 patients). Results: TFVD measured 2.23 ± 1.01 mm at 2.5 cm proximal to the plafond. TFVD occurred at 25% of the distance from 2 to 3 mm in 47.6% of patients. This new technique decreased the deformation of AAS by 75%, from 13.06 ± 2.55° to 4.28 ± 1.72°, in the conventional group.Conclusions: Placing a 1.6-mm K-wire in the syndesmosis at 2.5 cm proximal to the tibial plafond is easy because of emerging TFVDs. Compared to the conventional method, this new technique increased the accuracy of syndesmotic screw placement by up to 75 percent. Therefore, K-wire could be used as a reliable and static intraoperative reference of the fibular incisura plane through which surgeons can accurately place a screw trajectory.

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Preliminary Report of Arthroscopically Assisted Sauvé–Kapandji Procedure for Distal Radioulnar Joint Arthritis

Journal of Wrist Surgery ◽

10.1055/s-0040-1721854 ◽

2021 ◽

Author(s):

Yukio Abe ◽

Youhei Takahashi ◽

Kenzo Fujii

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Kirschner Wire ◽

Distal Radioulnar Joint ◽

Contralateral Side ◽

Level Of Evidence ◽

Radioulnar Joint ◽

Advantages And Disadvantages ◽

Arthroscopically Assisted ◽

Therapeutic Study

Abstract Background The arthroscopically assisted Sauvé–Kapandji (S-K) procedure has been described as a safe and promising technique for distal radioulnar joint (DRUJ) arthrodesis. Our purpose was to investigate the advantages and disadvantages of the arthroscopically assisted S-K procedure. Methods Eight patients underwent an arthroscopically assisted S-K procedure. All patients were diagnosed as DRUJ osteoarthritis (OA), including six primary DRUJ OA, one OA following a distal radius fracture, and one rheumatoid arthritis (RA). Arthroscopy was performed in neutral forearm rotation with vertical traction. The surface of the DRUJ was debrided through arthroscopy to expose the subchondral surface, and the DRUJ was fixed with a cannulated screw and Kirschner wire (K-wire) with zero or minus ulnar variance in the same posture. Bone graft was not performed. Results Bone union was achieved at 2 to 3.5 months postoperatively. At an average of 17-month follow-up, the pain intensity on 10-point numerical rating scale (NRS) decreased from 10 preoperatively to 0.4 postoperatively, average range of pronation significantly improved from 77 degrees to 89 degrees, and average grip strength as a percentage of contralateral side improved from 76 to 104%. Conclusion Satisfactory outcomes were achieved with the arthroscopically assisted S-K procedure. Advantages of this procedure included the ability to achieve union without bone grafting, preservation of the extensor mechanism integrity, and easy reduction of the ulnar head due to its wrist positioning. No major complications were encountered. Disadvantages included its required use of arthroscopic technique and potential contraindication for cases with severe deformity at the sigmoid notch. Level of Evidence This is a Level IV, therapeutic study.

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Ankle Fracture with Syndesmosis Separation : Radiographic Landmark and Results of Trans-Syndesmotic Screw Fixation

Journal of the Korean Fracture Society ◽

10.12671/jksf.1999.12.4.948 ◽

1999 ◽

Vol 12 (4) ◽

pp. 948

Author(s):

Chong Kwan Kim ◽

Byung Woo Ahn ◽

Sang Guk Lee ◽

Young Hwan Kim ◽

Chae Ik Chung ◽

...

Keyword(s):

Ankle Fracture ◽

Screw Fixation ◽

Syndesmotic Screw

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Surgical anatomy of the pelvic vasculature, with particular reference to acetabular screw fixation in cementless total hip arthroplasty in Asian population

Journal of Orthopaedic Surgery ◽

10.1177/2309499016685520 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668552 ◽

Cited By ~ 2

Author(s):

Hironori Ohashi ◽

Shinichi Kikuchi ◽

Shigeo Aota ◽

Michiyuki Hakozaki ◽

Shinichi Konno

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Vascular Injury ◽

Hip Arthroplasty ◽

Screw Fixation ◽

Kirschner Wire ◽

Safety Zone ◽

Total Hip ◽

Cementless Total Hip Arthroplasty ◽

Posterior Area

Purpose: Pelvic vascular injury is a serious complication associated with acetabular component setting with screw fixation in cementless total hip arthroplasty (THA). In this study, we investigated the safety zone for acetabular component setting with screw fixation in cementless THA as a means to prevent pelvic vascular injury. Methods: Thirty left hip joints of Japanese cadavers (11 males and 19 females) were analyzed. We used a hemispherical measuring cup with 52 guide holes designed to allow vertical insertion of a Kirschner wire. After the measuring cup was placed on the acetabulum, the Kirschner wire was inserted from each guide hole to examine the anatomical relationship between the acetabulum and the pelvic vessels. We calculated the frequency of pelvic vessel punctures and measured the distance from the acetabular surface to the pelvic vessels at each guide hole. Results: Our findings revealed that pelvic vessels do not exist in certain parts of the posterior area of the acetabulum. Furthermore, in this area, intrapelvic vessels are either lacking or located at a distance ≥31 mm from the surface of the acetabulum. Conclusion: The posterior area of the acetabulum, excluding its central portion, appeared to be the safety zone for acetabular screw fixation in Japanese cadavers.

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The Clinical Efficacy of Suture-button Fixation and Trans-syndesmotic Screw Fixation in the Treatment of Ankle Fracture Combined with Distal Tibiofibular Syndesmosis Injury: A Retrospective Study

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2021.07.009 ◽

2021 ◽

Author(s):

Yibo Xu ◽

Ran Kang ◽

Ming Li ◽

Zhong Li ◽

Teng Ma ◽

...

Keyword(s):

Retrospective Study ◽

Clinical Efficacy ◽

Ankle Fracture ◽

Screw Fixation ◽

Tibiofibular Syndesmosis ◽

Suture Button ◽

Syndesmotic Screw ◽

Distal Tibiofibular Syndesmosis ◽

Syndesmosis Injury

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Changes in the syndesmotic reduction after syndesmotic screw fixation for ankle malleolar fractures: One-year longitudinal evaluations using computer tomography

Injury ◽

10.1016/j.injury.2016.07.031 ◽

2016 ◽

Vol 47 (10) ◽

pp. 2360-2365 ◽

Cited By ~ 6

Author(s):

Jun Endo ◽

Satoshi Yamaguchi ◽

Masahiko Saito ◽

Tsuguo Morikawa ◽

Ryuichiro Akagi ◽

...

Keyword(s):

Computer Tomography ◽

Screw Fixation ◽

Malleolar Fractures ◽

Syndesmotic Screw ◽

One Year

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A Novel Device for Accurate Guide wire Placement in Cannulated Screw Fixation of Femoral Neck Fracture:A Pilot Study

10.21203/rs.3.rs-57323/v1 ◽

2020 ◽

Author(s):

bu-fang ren ◽

quan-ping Ma ◽

xin lv

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Screw Fixation ◽

Kirschner Wire ◽

Operation Time ◽

Conventional Technique ◽

Novel Device ◽

Neck Fracture ◽

Guide Device ◽

Experimental Group

Abstract Background: Accurate placement of cannulated screws is the key to stable fixation of the femoral neck fracture. A novel device was developed to improve the accuracy of screw placement.Methods: 20 synthetic femoral bones were divided into conventional technique group and the experimental group. Three Kirschner wire were inserted into the femoral neck fracture by conventional technique or by the simple guide device. The operative time, total drilling times and fluoroscopic frequency were evaluated.Results: By using the guide device, the fluoroscopy and operation time of the experimental group were shorter that of the conventional method. The total drilling times with the simple guide device were significantly lower than the conventional technique group.Conclusions: This device can help trauma surgeons shorten the surgical time and reduce radiation exposure time. The use of this guide device can make screw fixation for femoral neck fracture easier.

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