Forceps reduction of the syndesmosis in rotational ankle fractures: A cadaveric study

Background: Recent studies have shown that it is difficult to accurately reduce and assess the reduction of the syndesmosis after ankle injury. The syndesmosis is most commonly reduced with use of reduction clamps to compress across the tibia and fibula. However, intraoperative techniques to optimiz...

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Main Authors: Phinit Phisitkul, Thomas Ebinger, Jessica Goetz, Tanawat Vaseenon, J. Lawrence Marsh
Format: Journal
Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/51821
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spelling th-cmuir.6653943832-518212018-09-04T06:09:45Z Forceps reduction of the syndesmosis in rotational ankle fractures: A cadaveric study Phinit Phisitkul Thomas Ebinger Jessica Goetz Tanawat Vaseenon J. Lawrence Marsh Medicine Background: Recent studies have shown that it is difficult to accurately reduce and assess the reduction of the syndesmosis after ankle injury. The syndesmosis is most commonly reduced with use of reduction clamps to compress across the tibia and fibula. However, intraoperative techniques to optimize forceps reductions to restore syndesmotic relationships accurately have not been systematically studied. The purpose of the present study was to evaluate the accuracy of syndesmosis reduction with different rotational vectors of clamp placement. Methods: Ten through-the-knee cadaveric specimens were used. Markers were placed on the tibia and fibula to produce consistent clamp placement and radiographic evaluation. A computed tomographic scan of the ankle was made to serve as a control, followed by a stepwise destabilization of the anterior inferior tibiofibular ligament, syndesmosis, deltoid ligament, small posterior malleolus fracture, and large posterior malleolus fracture. Following each step in the destabilization, clamps were applied to compress the syndesmosis at varying angles and computed tomography was performed to measure the alignment of the syndesmosis as compared with that on the control scan. Results: In all degrees of induced instability, and for all vectors of clamp placement, a small but consistent amount of overcompression of the syndesmosis was observed. The average overcompression (and standard deviation) for all samples was 0.93 ± 0.70 mm. Both obliquely oriented clamp arrangements consistently caused fibular malreductions in the sagittal plane. Placing the clamp in the neutral anatomical axis reduced the syndesmosis most accurately, with an average displacement of 0.1 ± 0.77 mm compared with control through all degrees of instability. Conclusions: Clamp placement in the neutral anatomical axis reduced the syndesmosis most accurately in our cadaveric model, although slight overcompression was frequently observed. Placing the clamp obliquely malreduced the unstable syndesmosis. Clinical Relevance: Clamp placement in the neutral anatomical axis appears to be preferred in the syndesmosis reduction. Copyright © 2012 by the Journal of Bone and Joint Surgery, Incorporated. 2018-09-04T06:09:45Z 2018-09-04T06:09:45Z 2012-12-19 Journal 15351386 00219355 2-s2.0-84871506457 10.2106/JBJS.K.01726 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84871506457&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/51821
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Phinit Phisitkul
Thomas Ebinger
Jessica Goetz
Tanawat Vaseenon
J. Lawrence Marsh
Forceps reduction of the syndesmosis in rotational ankle fractures: A cadaveric study
description Background: Recent studies have shown that it is difficult to accurately reduce and assess the reduction of the syndesmosis after ankle injury. The syndesmosis is most commonly reduced with use of reduction clamps to compress across the tibia and fibula. However, intraoperative techniques to optimize forceps reductions to restore syndesmotic relationships accurately have not been systematically studied. The purpose of the present study was to evaluate the accuracy of syndesmosis reduction with different rotational vectors of clamp placement. Methods: Ten through-the-knee cadaveric specimens were used. Markers were placed on the tibia and fibula to produce consistent clamp placement and radiographic evaluation. A computed tomographic scan of the ankle was made to serve as a control, followed by a stepwise destabilization of the anterior inferior tibiofibular ligament, syndesmosis, deltoid ligament, small posterior malleolus fracture, and large posterior malleolus fracture. Following each step in the destabilization, clamps were applied to compress the syndesmosis at varying angles and computed tomography was performed to measure the alignment of the syndesmosis as compared with that on the control scan. Results: In all degrees of induced instability, and for all vectors of clamp placement, a small but consistent amount of overcompression of the syndesmosis was observed. The average overcompression (and standard deviation) for all samples was 0.93 ± 0.70 mm. Both obliquely oriented clamp arrangements consistently caused fibular malreductions in the sagittal plane. Placing the clamp in the neutral anatomical axis reduced the syndesmosis most accurately, with an average displacement of 0.1 ± 0.77 mm compared with control through all degrees of instability. Conclusions: Clamp placement in the neutral anatomical axis reduced the syndesmosis most accurately in our cadaveric model, although slight overcompression was frequently observed. Placing the clamp obliquely malreduced the unstable syndesmosis. Clinical Relevance: Clamp placement in the neutral anatomical axis appears to be preferred in the syndesmosis reduction. Copyright © 2012 by the Journal of Bone and Joint Surgery, Incorporated.
format Journal
author Phinit Phisitkul
Thomas Ebinger
Jessica Goetz
Tanawat Vaseenon
J. Lawrence Marsh
author_facet Phinit Phisitkul
Thomas Ebinger
Jessica Goetz
Tanawat Vaseenon
J. Lawrence Marsh
author_sort Phinit Phisitkul
title Forceps reduction of the syndesmosis in rotational ankle fractures: A cadaveric study
title_short Forceps reduction of the syndesmosis in rotational ankle fractures: A cadaveric study
title_full Forceps reduction of the syndesmosis in rotational ankle fractures: A cadaveric study
title_fullStr Forceps reduction of the syndesmosis in rotational ankle fractures: A cadaveric study
title_full_unstemmed Forceps reduction of the syndesmosis in rotational ankle fractures: A cadaveric study
title_sort forceps reduction of the syndesmosis in rotational ankle fractures: a cadaveric study
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84871506457&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/51821
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