Distal tibiofibular syndesmosis fibular notch typing and its clinical significance based on CT / 解剖学报

Objective To investigate the morphological typing and clinical significance of the distal tibiofibular syndesmosis fibular notch based on CT images. Methods According to the inclusion and exclusion ceiteria‚ the imaging data of patients undergoing ankle joint CT examination were analyzed‚ and the inferior tibiofibular joint fibula notch was classified according to the morphological characteristics. The measurements included 8 distances. There were 123 males and 102 females‚ all of whom were Han nationality‚ aged 18-60 years old. Results Retrospectively analyzed the result of 225 patients from December 2013 to December 2022. The distal tibiofibular syndesmosis fibular notch was divided into four types according to morphological characteristics‚ C-shaped (50. 67%)‚ V-shaped (26. 67%)‚ flat-shaped (15. 11%) and L-shaped (7. 56%). The angle between the anterior and posterior facets of the flat shape (145. 56 ± 9. 25)° was the largest and the angle between the anterior and posterior facets of the L shape (125. 07 ± 13. 54)° was the smallest(P< 0. 05); the depth of the notch in the flat shape (3. 11 ± 0. 83) mm was the smallest and in the L shape (4. 47±1. 11) mm was the largest(P<0. 05);The posterior facet length (13. 06 ± 3. 56) mm and anterior tibiofibular gap (3. 83±1. 49) mm on left were larger than on the right side (P<0. 05); The posterior facet length (13. 36 ± 3. 46) mm‚ fibular notch depth (3. 93 ± 1. 10) mm and vertical distance of tibiofibular overlap (9. 10 ± 2. 55) mm larger in men than in women (P<0. 05). Conclusion In this study‚ the data related to the inferior tibiofibular syndesmosis notch were measured and divided into four types according to the shape. The flat inferior tibiofibular syndesmosis notch is more likely to have chronic ankle instability‚ and the fibula is more likely to move forward during anatomical reduction. The inferior tibiofibular syndesmosis of L-shaped and C-shaped notches is more prone to posterior displacement of fibula or poor rotation reduction during anatomical reduction.

TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament in treatment of distal tibiofibular syndesmosis injury / 中国修复重建外科杂志

OBJECTIVE@#To study the effectiveness of TightRope elastic fixation combined with functional total repair of the inferior tibiofibular ligament in the treatment of distal tibiofibular syndesmosis injury.@*METHODS@#The clinical data of 34 patients with distal tibiofibular syndesmosis injury who met the selection criteria between January 2020 and January 2022 were retrospectively analyzed, and they were divided into improved group (TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament) and control group (distal tibiofibular screw fixation) according to the surgical methods, with 17 cases in each group. There was no significant difference in age, gender, body mass index, fracture type, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded in the two groups. The American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle metatarsal flexion and dorsal extension range of motion were used to evaluate the ankle function. The patient satisfaction survey was conducted at last follow-up.@*RESULTS@#All 34 patients were followed up 8-20 months, with a median of 13 months. The operation time and intraoperative blood loss in the improved group were significantly longer than that in the control group (P<0.05). In the improved group, no infection or poor reduction occurred, and only 1 patient had TightRope knot reaction at 6 months after operation. In the control group, there were 2 cases of poor reduction, 1 case of lower tibiofibular screw rupture, and 1 case of subcutaneous infection (cured after anti-infection treatment). There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS score and ankle metatarsal flexion and dorsal extension range of motion of the improved group were significantly better than those of the control group (P<0.05). The satisfaction rates of patients in the improved group and the control group were 94.1% and 82.4%, respectively, showing significant difference (P<0.05).@*CONCLUSION@#TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament in the treatment of distal tibiofibular syndesmosis injury has sufficient fixation strength, and can achieve better effectiveness and joint function compared with traditional screw fixation.

Current research on injury to the distal tibiofibular syndesmosis and prospects of its treatment / 中华创伤骨科杂志

Among ankle injuries, the injury to the distal tibiofibular syndesmosis is common and likely neglected. The stability of the distal tibiofibular syndesmosis is related to the depth of the fibular notch. In imaging diagnosis, X-ray examination cannot be used for a definite diagnosis of the injury to the distal tibiofibular syndesmosis. For diagnosis of the distal tibiofibular separation>3 mm, CT scan can be accurate but is not sensitive enough for a separation<1 mm while MRI is more sensitive in diagnosis of the injury. Arthroscopy has gradually been used as the "gold standard" in diagnosis of the injury to the distal tibiofibular syndesmosis due to its advantage of direct vision. The distal tibiofibular separation occurs in the injuries of pronation external rotation Ⅳ°, supination external rotation Ⅲ° and Ⅳ°, and pronation abduction Ⅱ° and Ⅲ° by the Lange-Hansen classification. Most patients with simple stable injury to the distal tibiofibular syndesmosis may have a good prognosis after nonoperative treatment. Surgical anatomic reduction and maintenance of stability of the distal tibiofibular syndesmosis are the basic management principles for unstable distal tibiofibular syndesmosis or the injury to the distal tibiofibular syndesmosis combined with ankle fracture. Screw fixation is the most commonly used in the surgical treatment of the injury. Elastic fixation has the advantages of maintaining the biological characteristics of the distal tibiofibular syndesmosis fretting joint, better reduction fault tolerance, and lower rates of complications and long-term reduction loss. The angle of nail placement is the key to maintaining good reduction of the distal tibiofibular syndesmosis, but there has been little description of the specific methods to ensure the theoretical angle of nail placement in practice. This article also reviews the prospects of the future treatment of the injury to the distal tibiofibular syndesmosis.

Sindesmosis tibioperonea: diagnóstico, métodos de fijación y artroscopia

Introducción: Las lesiones de la sindesmosis tibioperonea son frecuentes tanto de forma aislada o asociadas a fracturas del maléolo posterior. El diagnóstico clínico es corroborado mediante estudios imagenológicos. Los métodos de fijación pueden ser rígidos o dinámicos. Objetivo: Actualizar aspectos sobre las lesiones de la sindesmosis tibioperonea en cuanto al diagnóstico, métodos de fijación y el empleo de la vía artroscópica. Método: La búsqueda y análisis de la información se realizó en un periodo de 61 días (1 de octubre al 30 de noviembre de 2022) y se emplearon las siguientes palabras: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 258 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote. Desarrollo: Se hizo referencia a las maniobras clínicas para el diagnóstico y las clasificaciones tomográficas en caso de fractura asociada del maléolo posterior. Se mencionaron los métodos de fijación rígidos y dinámicos, donde se describieron las características de cada uno basado en varios factores. Se expusieron las ventajas de la vía artroscópica tanto para el diagnóstico como para el tratamiento. Conclusiones: Las lesiones de la sindesmosis tibioperonea distal son frecuentes. Los estudios tomográficos ofrecen ventajas al determinar la extensión de la fractura del maléolo posterior. La vía artroscópica ofrece múltiples ventajas diagnósticas y terapéuticas.

Introduction: Tibioperoneal syndesmosis injuries are frequent both in isolation or associated with posterior malleolus fractures. Clinical diagnosis is confirmed on imaging studies. Fixation methods might be rigid or dynamic as well. Objective: Provide new aspects related to tibioperoneal syndesmosis injuries in terms of diagnosis, fixation methods and the use of arthroscopic procedure. Method: Search and analysis of information needed were carried out in a period of 61 days (from October 1 to November 30, 2022) and the following words were used: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. Based on the information obtained, a bibliographic review of the total of 258 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search engine and reference manager EndNote. Development: It was expressed in the study aspects related to clinical management used in diagnostic and classification on the types of CT scan for fracture associated with posterior malleolar fracture. The rigid and dynamic fixation methods and its characteristics were mentioned as well. The arthroscopic approaches and its advantages for both diagnosis and treatment were presented. Conclusions: Distal tibioperoneal syndesmosis injuries are frequent ankle injury. Tomographic studies offer some advantages for determining how large the posterior malleolus fracture is. The arthroscopic approach offers multiple diagnostic and therapeutic advantages too.

Introdução: As lesões da sindesmose tibiofibular são frequentes isoladamente ou associadas a fraturas do maléolo posterior. O diagnóstico clínico é confirmado por exames de imagem. Os métodos de fixação podem ser rígidos ou dinâmicos. Objetivo: Atualizar aspectos das lesões da sindesmose tibiofibular quanto ao diagnóstico, métodos de fixação e uso da abordagem artroscópica. Método: A busca e análise das informações foi realizada em um período de 61 dias (1º de outubro a 30 de novembro de 2022) e foram utilizadas as seguintes palavras: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. Com base nas informações obtidas, foi realizada uma revisão bibliográfica de um total de 258 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline, utilizando o gerenciador de busca e Gerenciador de referências do EndNote. Desenvolvimento: Foi feita referência a manobras clínicas para diagnóstico e classificações tomográficas em caso de fractura associada do maléolo posterior. Foram citados métodos de fixação rígidos e dinâmicos, onde foram descritas as características de cada um com base em vários fatores. As vantagens da abordagem artroscópica tanto para o diagnóstico quanto para o tratamento foram discutidas. Conclusões: As lesões da sindesmose tibiofibular distal são frequentes. Os estudos tomográficos oferecem vantagens na determinação da extensão da fratura do maléolo posterior. A abordagem artroscópica oferece múltiplas vantagens diagnósticas e terapêuticas.

Mechanics Analysis on Novel Micro-Movement Elastic Implant of Distal Tibiofibular Syndesmosis in Dorsiflexion Position / 医用生物力学

Objective To study mechanical properties of the novel micro-movement elastic implant of distal tibiofibular syndesmosis in dorsiflexion position.Methods A combination of simulation and experiment was used. The normal ankle dorsiflexion model, the bone nail repaired model and the micro-movement elastic implant repaired model were established by using Mimics and CT data. Besides, ANSYS Workbench was used for finite element analysis. Mechanical experiments on lower limb specimens were conducted on Instron E10000 mechanical test instrument, and five sets of experimental data were measured and analyzed.Results Mechanical properties of the micro-movement elastic implant repaired model were closer to those of the normal ankle dorsiflexion model, but stress of the micro-movement elastic implant repaired mode was greater than that of the bone nail repaired model. The results of two-sample heteroscedasticity t test indicated that there was no significant difference in resistance torque between the micro-movement elastic implant repaired model and the normal ankle dorsiflexion model.Conclusions For dorsiflexion position, repairing mechanical properties of the novel micro-movement elastic implant are much better than those of the bone nail, and there is still room for optimizing the micro-movement elastic implant.

Proximal tibiofibular stabilization by anatomical ligamentoplasty and diaphyseal osteotomy of the fibula / 中华创伤杂志(英文版)

Proximal tibiofibular instability is a rare condition for which treatment is poorly codified. A 21-year-old patient, a leisure sportswoman, presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion. We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses. This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.

Anatomical characteristics and clinical significance of the syndesmosis based on MRI / 解剖学报

Objective To discuss the anatomical characteristics of the syndesmotic ligament based on MRI images, and to provide anatomical basis for clinical syndesmotic ligament injury and ligament reconstruction. Methods Totally 228 cases of MRI data from diseased person enrolled in the Orthopedics and Traumatology Department of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from January 2010 to May 2021 were retrospectively studied. Measurement of corresponding geometrical data of the ligaments in syndesmosis were analysed. Results The average length of the syndesmosis anterior ligament was (9. 75±3. 54) mm, the average width (7. 27±3. 09) mm, and the average thickness (2. 50± 0. 93 ) mm. The angle with the horizontal plane was ( 47. 49 ± 14. 60) ° ; The average length of the posterior syndesmosis ligament of the lower tibia and fibula was (8. 94±2. 43) mm, the average width was (6. 70±2. 80) mm, the average thickness was (2. 32±1. 10) mm, and the angle with the horizontal plane was (40. 84±13. 13)°; the average length of the inferior transverse ligament was (9. 81±3. 21) mm, the average width was (2. 28±1. 51) mm, and the angle with the horizontal plane was 14. 59° ± 8. 02°; the average length of the inferior tibiofibular syndesmosis interosseous ligament was (12. 92±4. 77) mm, and the average width was (3. 28±1.99) mm. The anatomical data of the anterior, posterior, inferior transverse, and interosseous ligaments of the lower tibiofibular syndesmosis, male and female, were compared, and the differences were not statistically significant. Conclusion Studying the anatomical structures and characteristics of the syndesmotic ligament and analyzing the effect of the syndesmotic ligament on the stability of the ankle joint can offer effective diagnostic means or suggestions of syndesmosis injuries in the clinically diagnose and treat.

Luxación tibiofibular proximal diagnóstico y tratamiento / Proximal tibiofibular joint dislocation diagnosis and treatment

Resumen: Introducción: La luxación tibiofibular proximal (LTFP) es una lesión poco frecuente y no diagnosticada. De no ser tratada a tiempo, puede generar una sintomatología crónica de dolor e inestabilidad. La escasa evidencia disponible no entrega un protocolo de enfrentamiento ni consenso respecto a su manejo. Con el objetivo de asistir al enfrentamiento de esta lesión, se presenta una revisión de la literatura de una LTFP con reducción espontánea. Caso clínico: Hombre de 22 años consulta por dolor intenso en su rodilla derecha, posterior a caída en cuatrimoto. Al examen físico con aumento de volumen doloroso en cara lateral de la rodilla y pierna proximal, con movilidad completa y estable. Radiografías son informadas sin alteraciones. Se mantiene la sospecha clínica de LTFP, se continúa estudio con resonancia magnética (RM), la que es sugerente de LTFP. Dentro de las 24 horas de evolución, el paciente indica haber sentido un clank espontáneo en su rodilla afectada con cese completo de sintomatología. Se sigue al paciente por tres meses con RM de control, manteniendo una rodilla asintomática; examen físico y funcionalidad normal. Conclusión: El diagnóstico de las LTFP requiere un adecuado uso de imágenes. Su manejo consiste en una reducción cerrada de urgencia y de no lograrse, una reducción abierta, reparación y fijación interna. El pronóstico de las reducciones espontáneas es incierto, por lo que deben ser seguidas de forma seriada y en caso de recidiva, manejadas quirúrgicamente según el tiempo de evolución.

Abstract: Introduction: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology. Case report: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud «clank¼. He has been followed for three months with MRI, and remains asymptomatic with full functions. Conclusion: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.

Fascículo distal del ligamento tibiofibular anterior: presencia, biometría y relación con la tróclea talar / Distal fascicle of the anterior tibiofibular ligament: presence, biometric characteristics and relation with the talar trochlea

El ligamento tibiofibular anterior suele presentar un fascículo distal independiente de la banda principal, denominado fascículo distal del ligamento tibiofibular anterior (FD-LTFA). Este discurre oblicuamente, cubriendo sus fibras más inferiores la zona anterolateral de la articulación talocrural. Su presencia se asocia a pellizcamiento del tobillo en esta zona, el cual puede producir un desgaste cartilaginoso de la cara anterolateral de la tróclea talar. El propósito de este estudio fue determinar la presencia y biometría del FD-LTFA, y su relación con la troclea talar en tobillos de un grupo de individuos Chilenos. En este estudio se utilizaron 30 miembros inferiores de cadáveres de individuos adultos. Se evaluó en el fascículo distal: Ancho en la inserción tibial, ancho en la inserción fibular, longitud del margen superior, longitud del margen inferior y el espesor. Se determinó si había contacto talar por parte del FD-LTFA y se observó desgaste articular en la superficie del domo talar, a nivel de la región de contacto del mencionado ligamento. El FD-LTFA fue encontrado en un 76,7 % de los casos, su anchura a nivel del sitio de fijación tibial fue de 5,30 mm (± 1,4) y a nivel fibular 4,43 mm (± 0,85). En cuanto a su longitud en el margen superior fue de 14,26 mm (± 3,66) y a nivel del margen inferior fue de 16,74 mm (± 2,91). Su espesor fue de 2,1 mm (± 0,36). En las 23 muestras de tobillo con presencia del FD-LTFA, hubo contacto talar en el 100 % de los casos y desgaste articular en esta zona en 3 de ellas (13,04 %). Los datos biométricos aportados por este estudio complementarán el conocimiento anatómico del FD-LTFA en la población Chilena.

The anterior tibiofibular ligament usually presents an independent distal fascicle of the main band, denominated distal fascicle of the anterior tibiofibular ligament (DF-ATiFL). Which obliquely passes, covering its most inferior fiber to the anterolateral corner of the talocrural articulation. Its presence is associated with the anterolateral impingement of the ankle in this area, which can produce cartilage wear of the anterolateral surface of the talar trochlea. The purpose of this study was to determine the presence and biometry of DF-ATiFL and its relation with the talar trochlea on the ankles of a group of Chilean individuals. Thirty inferior members were used in this study, all from adult individuals. It was evaluated: Width of the tibial insertion, width of the fibular insertion, length of the top margin, length of the bottom margin, and the thickness. It was determined whether there was talar contact by the distal fascicle of the anterior tibiofibular ligament. Also, it was observed the articular wear on the surface of the talar dome, at the level of the contact region of the distal fascicle of the anterior tibiofibular ligament. The DFATiFL was found in 76.7 % of the cases, its width at the level of the place of tibial fixation was 5.30 mm (± 1.40), and at the fibular level 4.43 mm (± 0.85). Regarding its length on the top margin was 14.26 mm (± 3.66), and at the bottom, the margin level was 16.74 mm (± 2.91). Its thickness was 2.1 mm (± 0.36). In the 23 ankles samples with the presence of DF-ATiFL, there was talar contact in 100 % of the cases and articular wear in this area in 3 of them (13.04 %). The biometric data contributed by this study will supplement the anatomical knowledge of the distal fascicle of the anterior tibiofibular ligament on the Chilean population.

Surgical effectiveness of ankle "Logsplitter" injury plus avulsion fractures without tibiofibular joint screwing / 中华创伤骨科杂志

Objective To explore the surgical efficacy of trans-syndesmotic ankle fracture dislocation (the "Logsplitter" injury) plus the Tillaux-Chaput fracture / the Wagstaffe-Lefort fracture and the Volkmann fracture without tibiofibular joint screwing.Methods Between January 2015 and December 2018,16 adult patients with the "Logsplitter" injury plus avulsion fractures were treated by open reduction and internal fixation at Department of Orthopaedics,The Sixth Affiliated Hospital,Xinjiang Medical University.They were 11 males and 5 females with an average age of 36.4 years (range,from 27 to 56 years).There were 2 open fractures (one type Ⅱ and one type ⅢA by the Anderson-Gustilo classification) and 14 closed ones;all fractures were type 44-C by the AO/OTA classification;according to the Lauge-Hansen classification,there were 9 cases of pronation-abduction rotation,3 cases of pronation-external rotation and 4 cases of supination-external rotation.The fibular fractures were treated through a single lateral approach followed by plate fixation.The Volkmann fractures were fixed with screws and the Tillaux-Chaput fractures / the Wagstaffe-Lefort fractures with screws or Kirschner wires.The ankle functions were assessed postoperatively using the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society (AOFAS),and the dysfunction index and bother index of Short Musculoskeletal Function Assessment (SMFA).Results All the patients were followed up for 8 to 27 months (average,21.3 months).X-ray films showed complete fracture healing in all cases after 12 to 18 weeks postoperatively (mean,14.8 weeks).At the last follow up,13 patients walked normally and 2 with mild discomfort.Their AOFAS scores averaged 96.3 (range,from 86 to 100),giving 12 excellent,3 good and one poor cases;their SMFA dysfunction index was 15.9 (range,from 8 to 17)and SMFA bother index 6.5 (range,from 3 to 9)at the last follow-up.Conclusions In the treatment of trans-syndesmotic ankle fracture dislocation — the "Logsplitter" injury,open reduction and internal fixation of the Tillaux-Chaput fracture / the Wagstaffe-Lefort fracture and the Volkmann fracture to reconstruct the lower tibiofibular horizontal stable "ring",without tibiofibular joint screwing,can obtain satisfactory clinical results.

Anatomy and clinical significance of the tibiofibular syndesmosis on anticorrosive specimens / 解剖学报

Objective To research the clinical significance of the tibiofibular syndesmosis based on the anatomical characteristics of the tibiofibular syndesmosis. Methods A total of 51 tibiofibular syndesmosis collected from Southwest Medical University were measured based on the anatomical characteristics of the lower tibia and fibula of anticorrosive specimens. Results The geometrical data of the anterior tibiofibular ligament, posterior tibiofibular ligament and transverse tibiofibular ligament were measured respectively, and mean ± standard deviation was described. Include: the length, width, thickness of the anterior tibiofibular ligament (8. 53±0. 69, 19. 06±1. 34, 15. 99±1. 44) mm, the length, width, thickness of the posterior tibiofibular ligament (9. 34±0. 63, 16. 92±1. 76, 14. 36±0. 89) mm, the length, width, thickness of the transverse tibiofibular ligament (18. 42±2. 48, 21. 93±2. 59, 4. 56±0. 17) mm. The angel between the anterior tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (20. 49±4. 86, 42. 20± 3. 42)°. The angel between the posterior tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (13. 2±2. 06, 40. 92±3. 13) °. The angel between the transverse tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (13. 45±1. 57, 32. 73±3. 70)°. According to the data analysis, the anterior, posterior and transverse tibiofibular ligaments have statistical difference between men and women, but there is no statistical difference between left and right feet. Conclusion The tibiofibular syndesmosis is of great significance to the stability of the ankle joint and the anatomical structure has important guiding significance for clinical treatment.

Fibular fixation in tibiofibular fractureses / Шинэ санаа Шинэ нээлт

Background@#Treatment of adult tibiofibular fractures, especially severely comminuted fractures, is technically challenging due to the lack of reduction markers and difficulty in restoring the alignment. Fixation of the fibula can facilitate reduction of the tibia fracture and restoration of the lower extremity alignment.@*Methods@#Between 2018-2019 we have operated on 50 patients who have lie on the same plane of tibiafibular fractures. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 3-month follow-up. The analysis was performed with STATA.@*Results@#Fixating fractures of tibia and fibula at same level were not shown to have complications on the development of nonunion including fibular shortening, hindfoot alignment, slow process of nonunion and unstableness.@*Conclusions@#We recommend fibular fixation in all 50 distal fractures when both fractures lie on the same plane and the tibial fracture is relatively stabilized.

Suture-button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury: A meta-analysis / 中国组织工程研究

BACKGROUND: In the clinical treatment of distal tibiofibular syndesmosis injury, Suture-Button fixation technique can achieve similar results to, even better results than, those of screws, but it cannot fully recover the anatomical reduction and activity to those before injury. However, the optimal treatment of distal tibiofibular syndesmosis injury is still controversial. OBJECTIVE: To systematically evaluate Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury. METHODS: EMBASE, Cochrane database, PubMed database, Wanfang database, and CNKI were searched to retrieve randomized or non-randomized controlled trials regarding Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury published from January 2005 to January 2019. The quality of the included studies was strictly evaluated. Relevant data were extracted. A meta-analysis of all outcome measures was performed using RevMan 5. 3 software. RESULTS AND CONCLUSION: (1) Twelve studies were included, including 4 randomized controlled trials and 8 cohort studies, involving 564 patients. (2) Meta-analysis results showed that Suture-Button fixation had shorter full weight-bearing time [WMD=-1. 50, 95%CI(-2. 08, -0. 92), P 0. 05). (3) These findings suggest that compared with screw fixation, Suture-Button fixation for the treatment of distal tibiofibular syndesmosis injury leads to better recovery of ankle joint function and an earlier time point for full weight bearing and does not need to consider the risk of screw fracture during the surgery. In addition to screw fixation, Suture-Button fixation is an effective way to treat distal tibiofibular syndesmosis injury.

A comparative study of Taylor spatial frame and unilateral external fixator in treatment of tibiofibular open fractures / 中国修复重建外科杂志

Objective: To compare the effectiveness of Taylor spatial frame (TSF) and unilateral external fixator in the treatment of tibiofibular open fractures. Methods: Between January 2016 and July 2018, 74 patients with tibiofibular open fracture who met the selection criteria were divided into TSF group (43 cases, fixed with TSF) and unilateral group (31 cases, fixed with unilateral external fixator) according to the principle of entering the group every other day. There was no significant difference in gender, age, affected side, cause of injury, type of fracture between the two groups ( P>0.05). The operation time, fracture healing time, removal time of external fixator, and complications were recorded and compared between the two groups. The limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effectiveness of tibial shaft fracture treatment. The recovery of lower limb force line was ecaluated by LUO Congfeng et al. criteria. Results: All patients were followed up 8-22 months, with a median of 12 months. All fractures healed, and no complication such as delayed union, nonunion, or osteomyelitis occurred. The operation time, fracture healing time, and removal time of external fixator in TSF group were significantly shorter than those in unilateral group ( P<0.05). At 3 months after the removal of the external fixator, the limb function was evaluated according to the Johner-Wruhs standard. In TSF group, 41 cases were excellent, 1 case was good, and 1 case was fair, and the excellent and good rate was 97.67%; in unilateral group, 30 cases were excellent and 1 case was fair, and the excellent and good rate was 96.77%; there was no significant difference between the two groups ( P=0.666). At 4 months after operation, the recovery of lower limb force line was ecaluated by LUO Congfeng et al. criterion. In TSF group, 41 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 97.67%; in unilateral group, 29 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was 96.77%; there was no significant difference between the two groups ( P=0.666). Conclusion: For tibiofibular open fracture, on the premise of fracture healing, TSF technology is superior to unilateral external fixation in terms of shortening operation time, fracture healing time, and removal time of external fixator.

Research progress in diagnosis and treatment of distal tibiofibular syndesmosis injury / 中国修复重建外科杂志

Objective: To review the research progress in the diagnosis and treatment of distal tibiofibular syndesmosis injury. Methods: The recent literature about distal tibiofibular syndesmosis injury was reviewed and analyzed. Results: Distal tibiofibular syndesmosis injury is commonly seen in ankle joint injury, the anatomical complexities make diagnosis and treatment difficult. Preoperative physical examination, radiologic evaluation, and intraoperative stress-testing are important for the diagnosis. Aggressive treatment is also recommended for these injuries to prevent long-term chronic instability. Internal fixation is the main treatment, including metal screw, degradable screw, elastic fixation, and hybrid techniques. Metal screw fixation is still the current mainstream, but elastic fixation represented by Suture-button is more in line with the physiological characteristics of ankle joint, and the rate of secondary operation is low while the clinical outcome is satisfactory. The application prospect of elastic fixation is worthy of expectation. Conclusion: It's crucial for patient with ankle fracture to repair the distal tibiofibular syndesmosis injury. How to diagnose the injury more accurately and simply, how to increase the success rate of reduction, and how to reduce the complications of surgery are still worthy for further exploration.

Progress in the Treatment of Logsplitter Injury: An Illustrated Review

Logsplitter injury is an ankle joint injury caused by high-energyaxial violence with significant separation of inferior tibiofibularsyndesmosis. Surgery is the mainstay treatment. The fractureshould be treated in stages depending on the condition of thesoft tissue. The integrity and smoothness of the ankle jointsurface should be restored as much as possible during thesurgery. This article discusses the treatment strategies oflogsplitter injuries. Thorough research of the availableliteratures was done aiming to provide a standard treatmentprotocol. When combined with posterior malleolus fracture,anatomical reduction of posterior malleolus is necessary toreconstruct posterior tibial notch and then lateral malleolus.This reduction sequence is very important. Anatomical lockingplates have been widely used in the fixation of fibular fractures.Anatomical reduction and fixation of the inferior tibiofibularsyndesmosis is the key factor to achieve good functionalresults. There are still some controversies on how to accuratelyjudge the stability of the inferior tibiofibular syndesmosis.Screws are the main method of fixing the inferior tibiofibularsyndesmosis at present. Ankle arthroplasty or anklearthrodesis may be necessary if the cartilage of the ankle jointis extensively damaged or if the ankle joint is severelycomminuted. At present, the therapeutic and prognostic effectsof these injuries are poor. The main influencing factors includethe degree of injury, anatomical reduction of the fracture anddislocation, recovery of ankle stability and the reconstruction ofankle joint surface.

Application of Taylor spatial frame combined with computer-assisted closed reduction in the treatment of tibiofibular fractures / 中国修复重建外科杂志

Objective: To explore the effectiveness of Taylor spatial frame (TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction. Methods: The clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group (15 cases, open reduction in TSF external fixation) and trial group (15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment. Results: Both groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group ( P<0.05). There were 2 cases of superficial infection of the external fixation (1 case in each group), 1 case of incision infection (control group), 1 case of delayed fracture healing (control group), 2 cases of traumatic arthritis (1 case in each group); no significant difference was found in the incidence of complications between the two groups ( χ2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups ( χ2=0.917, P=0.821). Conclusion: Compared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation, avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.

Management of High Ankle Sprain / 대한족부족관절학회지

High ankle sprain (distal tibiofibular syndesmosis injury) occurs from rotational injuries, specifically external rotation, and may be associated with ankle fractures. The prevalence of these injuries may be higher than previously reported because they may be missed in an initial examination. Syndesmosis injury can lead to significant complications in injured ankle joints, so a precise physical examination and radiological evaluation is necessary. The most important treatment goal is to have the tibia and fibula located in the correct position with respect to each other and to heal in that position. The methods to fix these injuries is controversial.

Progress in bioabsorbable screws used in treatment of injury to distal tibiofibular syndesmosis / 中华创伤骨科杂志

As injury to distal tibiofibular syndesmosis is commonly associated with ankle fractures,it calls for timely and correct diagnosis and treatment because it might result in chronic pain and ankle instability.Its severe cases can lead to traumatic arthritis.Stable injury to distal tibiofibular syndesmosis can be treated conservatively,but internal fixation is mostly recommended for severe cases of the injury.Internal fixation with metal screws usually requires a secondary surgery for removal of the implants but application of bioabsorbable screws overcomes this trouble and avoids a secondary surgery and its related complications.This article reviews the advantages of bio-absorbable screws,choice of bioabsorbable materials and screws,therapeutic outcomes and adverse reactions in the treatment of distal tibiofibular syndesmotic injury.

Ankle arthroscopy for diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis / 中华创伤骨科杂志

Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1％ (13/35),54.3％ (19/35),74.3％ (26/35) and 68.6％ (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI ＞ ankle arthroscopy ＞ CT ＞ C-arm roentgenography,with significant differences between them (P ＜ 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.