Isolated Syndesmotic Injury / 대한족부족관절학회지

Syndesmotic injury can either be isolated or associated with bony or ligamentous ankle injury. When it is not associated with an ankle fracture, it may not be easy to diagnose, especially when there is no franck diastasis on a plain radiograph. Without proper treatment, syndesmotic injury can lead to chronic pain due to impingement of scar tissues and instability. It may further lead to ankle arthritis. Early diagnosis with appropriate management is a prerequisite to avoid these problems. Herein, we review and discuss the mechanism of injury, classification, diagnosis, and treatment of isolated syndesmotic injury.

Results of Syndesmotic Screw Fixation versus Posterior Malleolus Fixation in Syndesmotic Injury at Pronation External Rotation Stage IV Ankle Fracture with Posterior Malleolus Fracture: Postoperative One Year Follow-up / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the radiologic and clinical results of syndesmotic screw fixation and posterior malleolar fixation for syndesmotic injury in Lauge-Hansen classification pronation-external rotation (PER) stage IV ankle fractures with posterior malleolus fracture. MATERIALS AND METHODS: We designed a retrospective study that included patients with Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture. Of 723 patients who underwent ankle fracture surgery from March 2005 to November 2012, 29 were included in this study. In this study, syndesmotic injury was treated with syndesmotic screw fixation or posterior malleolus fixation. There were 15 cases of syndesmotic screw fixation and 14 cases of posterior malleolar fixation. We compared the radiologic and clinical results at one year postoperatively. Posterior malleolus fragment size on a pre-operative computed tomographic image, and tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, and Takakura classification on a postoperative one year followup radiograph were used for comparison of the radiologic results. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society score, visual analogue scale score, and patient subjective satisfaction score. RESULTS: Posterior malleolar fragment size was 12.62%+/-3.01% of the joint space in the syndesmotic screw fixation group and 27.04%+/-4.34% in the posterior malleolar fixation group. A statistical difference was observed between the two groups. However, other results, including tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, Takakura classification, and clinical scores showed no statistical difference. CONCLUSION: In the Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture, if the posterior malleolus fracture can be reduced anatomically and fixated rigidly, syndesmotic screw fixation, which can cause several complications, is usually not required for achievement of a satisfactory syndesmotic stability; this would be a recommendable option for treatment of syndesmotic injury.

Evaluation of Intraoperative Stress Radiologic Tests for Syndesmotic Injuries / 대한족부족관절학회지

PURPOSE: To report the effectiveness of adding distal fibular external rotation stress test on the traditional lateral stress Cotton test in evaluating distal tibiofibular syndesmotic injuries. MATERIALS AND METHODS: We evaluated syndesmotic injuries with intraoperative stress test during treating ankle fractures from March 2009 to September 2010. External rotation of distal fibula using small elevator was added on traditional stress test in case of suspicious syndesmotic injury. We retrospectively reviewed and compared the results of each test in 44 cases for which we tried both tests. RESULTS: In 9 cases of positive traditional lateral stress tests, positive results were obtained in all cases by additional external rotation tests. In 21 cases of negative traditional stress tests, additional stress tests results were also negative. But there were 10 cases of positive additional tests and 4 of negative additional tests in equivocal results cases by the traditional stress tests. CONCLUSION: Using additional external rotation stress test in case of equivocal test result by the traditional lateral stress Cotton test for evaluation of syndesmotic injury during operation for ankle fracture can be a supplemental method to clarify syndesmotic injury needs fixation.

Anatomical Differences of the Fibular Incisura of the Tibia between Ankle Fracture with Syndesmotic Injury and without Syndesmotic Injury / 대한족부족관절학회지

PURPOSE: This study was performed to compare the anatomic differences of the fibular incisura of the tibia between ankle fractures with and without syndesmotic injuries. MATERIALS AND METHODS: 42 patients were involved in this study: Group I was composed with 14 cases of ankle fractures with syndesmotic injuries; Group II was composed with 14 cases of ankle fractures without syndesmotic injuries; Group III was composed with 14 cases of volunteers. The height averaged 170.1 cm (range, 159~181 cm) in group I, 168.9 cm (range, 156~184 cm) in group II, and 170.4 cm (range, 161~77 cm) in group III. The mean height did not show a statistically significant difference between groups (p>0.05). All patients were taken axial computed tomography. The length of anterior and posterior facets, angle between anterior and posterior facet, and depth of the fibular incisura of the tibia were measured. RESULTS: The mean length of the anterior facet was 11.5 mm (range, 9.2~15.7 mm) in group I, 12.2 mm (range, 7.3~17.0 mm) in group II, and 10.3 mm (range, 8.7~14.0 mm) in group III (p>0.05). The mean length of the posterior facet was 12.3 mm (range, 9.0~14.5 mm) in group I, 11.0 mm (range, 7.3~16.2 mm) in group II, and 13.0 mm (range, 9.2~15.9 mm) in group III (p>0.05). The mean angle between anterior and posterior facet was 139.1 degrees (range, 125.5~154.0 degrees) in group I, 144.2 degrees (range, 134.7~152.6 degrees) in group II, and 131.5 degrees (range, 117.6~144.4 degrees) in group III (p<0.05). The mean depth of the fibular incisura of the tibia was 4.1 mm (range, 3.2~5.8 mm) in group I, 4.6 mm (range, 3.1~7.1 mm) in group II, and 3.1 mm (range, 1.5~4.0 mm) in group III (p<0.05). CONCLUSION: There are some statistical differences of angle between anterior and posterior facet and depth of the fibular incisura of the tibia between ankle fractures with and without syndesmotic injuries.