Objectives: Radiologic criteria for syndesmosis instability evaluation remain controversial and direct visualization (DV) of the distal tibiofibular articulation is an alternative diagnostic method worthy of further investigation. We speculate that DV is a more accurate way to evaluate syndesmosis instability than fluoroscopy. The purpose of this study is to determine whether syndesmosis instability can accurately be recognized through DV and if this new intraoperative diagnostic method is more sensitive than fluoroscopy in detecting syndesmosis instability.
Methods: Ten cadaveric ankles were tested using a sequential iatrogenic syndesmosis injury model. Specimens were tested incrementally with the lateral stress test (LST) and the external rotation stress test (ERT). The resulting instability was measured directly and fluoroscopically with a true mortise view by using medial clear space (MCS) and tibiofibular clear space (TFCS).
Results: DV detected a 2-ligaments injury at a mean diastasis of 3.02 mm ( = 0.0077) and 3.19 mm ( = 0.0077) with the LST and ERT, respectively. Fluoroscopically, TFCS showed a significant diastasis only with a complete syndesmosis rupture while MCS did not show any significant differences.
Conclusions: DV of the syndesmosis in a cadaver injury model appears to be more sensitive than fluoroscopy in identifying injury, especially incomplete syndesmotic disruption.
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http://dx.doi.org/10.1097/OI9.0000000000000006 | DOI Listing |
J Foot Ankle Surg
January 2025
Trauma Unit, Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Electronic address:
Ankle fractures are often accompanied by syndesmotic injuries, contributing to instability and potential long term complications. Syndesmotic injuries are traditionally fixed with either small fragment (3.5-mm diameter) or large fragment (4.
View Article and Find Full Text PDFEur J Orthop Surg Traumatol
January 2025
Department of Orthopaedic Surgery, University of California San Diego, 200 West Arbor Drive MC 8894, San Diego, CA, 92103, USA.
Purpose: While treatment modalities for Maisonneuve fractures involving the proximal third of the fibula are established, no studies to date have reported outcomes associated with syndesmotic-only fixation of middle third fibular shaft fractures. The purpose of this study was to evaluate outcomes associated with syndesmotic-only fixation in the treatment of Maisonneuve fractures involving the middle third of the fibula.
Methods: A retrospective review was conducted on 257 cases of syndesmotic ankle instability with associated fibular fractures at a level 1 trauma center between 2013 and 2023.
J Bone Joint Surg Am
December 2024
Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
Background: The diagnosis of syndesmotic instability is challenging, and chronically unstable injuries can potentially lead to ankle arthritic degeneration. The objective of this cadaveric study was to utilize a 3-dimensional (3D) weight-bearing computed tomography (WBCT) distance mapping algorithm for the detection of subtle syndesmotic instability, induced by complete syndesmotic ligament sectioning and stressed by isolated axial load. We hypothesized that this algorithm would accurately detect subtle syndesmotic instability.
View Article and Find Full Text PDFJ Sci Med Sport
November 2024
Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, the Netherlands; Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, the Netherlands; Aspetar Orthopaedic and Sports Medicine Hospital, Department of Sports Medicine, Qatar. Electronic address: https://twitter.com/Jltol.
Purpose: To compare patient-reported outcomes between acute ligamentous ankle injuries 1) without anterior syndesmosis involvement and 2) with anterior syndesmosis involvement (without clinical instability).
Study Design: Prospective cohort study.
Methods: Between September 2016 and December 2020 all athletes (≥18) with an acute ankle injury presenting within 7 days post-injury were screened for eligibility.
J Orthop
January 2025
Department of Human Locomotion, Chemnitz University of Technology, 09126, Chemnitz, Germany.
Purpose: Supination trauma is a common sports injury, and often leads to chronic ankle instability. This study analyses whether indications of healing can be detected 2 weeks after supination trauma.
Methods: This prospective, monocentric study at a German Medical Center examined patients with acute supination trauma.
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