Dual Suture Button Fixation With Buttress Plate for Ankle Syndesmotic Injury.

SUMMARY: In this video, we present a unique approach to a purely ligamentous syndesmotic injury in a 16-year-old football player. Syndesmotic reduction was obtained using a large clamp and validated by matching fibular position to a fluoroscopic image of the contralateral ankle. Fixation was achieved using dual suture button devices in combination with a buttress plate. A small medial incision was used to protect the saphenous neurovascular bundle during button placement.

Multiple Ligament Knee Injuries: Does the Knee Dislocation Classification Predict the Type of Surgical Management?

This study aims to evaluate relationships among multiple ligament knee injury (MLKI) patterns as classified according to the knee dislocation (KD) classification and the types of surgical management pursued. We hypothesized that the KD classification would not be predictive of the types of surgical management, and that categorizing injuries according to additional injury features such as structure, chronicity, grade, and topographic location would be predictive of the types of surgical management. This is a Retrospective cohort study. This study was conducted at a level I trauma center with a 150-mile coverage radius. Query of our billing database was performed using combinations of 43 billing codes (International Classification of Diseases [ICD] 9, ICD-10, and Current Procedural Terminology) to identify patients from 2011 to 2015 who underwent operative management for MLKIs. There were operative or nonoperative treatment for individual ligamentous injuries, repair, or reconstruction of individual ligamentous injuries, and staging or nonstaging or nonstaging of each surgical procedure. The main outcome was the nature and timing of clinical management for specific ligamentous injury patterns. In total, 287 patients were included in this study; there were 199 males (69.3%), the mean age was 30.2 years (SD: 14.0), and the mean BMI was 28.8 kg/m2 (SD: 7.4). There were 212 injuries (73.9%) categorized as either KD-I or KD-V. The KD classification alone was not predictive of surgery timing, staging, or any type of intervention for any injured ligament (p > 0.05). Recategorization of injury patterns according to structure, chronicity, grade, and location revealed the following: partial non-ACL injuries were more frequently repaired primarily (p < 0.001), distal medial-sided injuries were more frequently treated operatively than proximal medial-sided injuries (odds ratio [OR] = 24.7; p <0.0001), and staging was more frequent for combined PCL-lateral injuries (OR = 1.3; p = 0.003) and nonavulsive fractures (OR = 1.2; p = 0.0009). The KD classification in isolation was not predictive of any surgical management strategy. Surgical management was predictable when specifying the grade and topographic location of each ligamentous injury. This is a Level IV, retrospective cohort study.

Multiple Ligament Knee Injuries: Current State and Proposed Classification.

Classification systems should enhance communication between providers, facilitate accurate and consistent reporting in the literature, and guide management. However, current classification systems for MLKIs lack sufficient detail to guide clinical management which limit their prognostic value. The purpose of this chapter is to revisit and consider important features of some of the most impactful classification systems developed in the orthopaedic literature and to propose a classification system for MLKIs that may improve communication among providers, facilitate consistent reporting in the literature, and ultimately foster publication of meaningful clinical data.