Abstract
In order to achieve a clinically satisfying result and to prevent posttraumatic osteoarthritis in the treatment of unstable syndesmotic injuries, anatomically correct reduction is crucial. The objective of the study was to investigate three different reduction methods of the ankle mortise in unstable syndesmotic injuries. In a specimen model with 38 uninjured fresh-frozen lower legs, a complete syndesmotic dissection was performed. The ankle mortise was reduced with either a collinear reduction clamp, a conventional reduction forceps or manually with crossing K-wires. The reduction clamps and the K-wires were placed in a 0°-angle to the leg axis. The clamps were positioned on the posterolateral ridge of the fibula 20 mm proximal to the ankle joint line. A cone beam computed tomography was performed after dissection and after each reduction. Tibio-fibular distances and angles were determined. Despite significant differences in terms of overcompression (0.09–0.33 mm; p = 0.000–0.063) and the slight external rotation (0.29–0.47°; p = 0.014–0.07), the results show a satisfying reduction of the ankle mortise. There were no considerable differences between the reduction methods. It can therefore be concluded that the ankle mortise can be reduced with any of the methods used, but that the positioning and the contact pressure must be considered.
Highlights
In order to achieve a clinically satisfying result and to prevent posttraumatic osteoarthritis in the treatment of unstable syndesmotic injuries, anatomically correct reduction is crucial
The hypothesis was that the collinear reduction clamp leads to a superior reduction in the cone beam computed tomography (CT) analysis compared to a standard bone reduction forceps or a manual reduction combined with a K-wire transfixation
The hypothesis posed was that the collinear reduction clamp accomplishes an anatomical reduction of the ankle mortise and is the most suitable reduction method
Summary
In order to achieve a clinically satisfying result and to prevent posttraumatic osteoarthritis in the treatment of unstable syndesmotic injuries, anatomically correct reduction is crucial. The objective of the study was to investigate three different reduction methods of the ankle mortise in unstable syndesmotic injuries. Intraoperative cone beam CT or postoperative CT are strongly recommended to avoid missing ankle malreduction in the treatment of unstable syndesmotic injuries[10,21]. The most common reduction method in the operative treatment of unstable syndesmotic injuries is the conventional bone. There are no studies on the collinear reduction clamp for unstable ankle injuries, but good reduction results have been demonstrated in other fracture regions such as the acetabulum[25]. The hypothesis was that the collinear reduction clamp leads to a superior reduction in the cone beam CT analysis compared to a standard bone reduction forceps or a manual reduction combined with a K-wire transfixation
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