Abstract
BackgroundThis study aims to investigate the malreduction of syndesmosis and its effects on stability.MethodsThe biomechanical tests, including the three-dimensional (3D) displacement of the syndesmotic incisura, fibular rotation angle, and torque resistance, were performed on six cadaver legs. These specimens were first tested intact (intact group), then cut all the syndesmotic ligaments and fixed in anatomical position (anatomical model group) and test again. After that, syndesmosis was fixed in 1 cm malreduction (anterior and posterior displacement group) to do the same test.ResultsIn internal or external load, there were significant differences in torque resistance and fibular rotation angle (internal t = 2.412, P = 0.036; external t = 2.412, P = 0.039) between the intact and post-malreduction groups. In internal rotation load, there were significant differences in sagittal displacement between the intact and post-malreduction groups (P = 0.011), and between the anatomical and post-malreduction groups (P = 0.020). In external rotation load, significant differences existed between the intact and ant-malreduction group (P = 0.034) in sagittal (anterior-posterior) displacement. Significant differences also existed between the intact and post-malreduction groups (P = 0.013), and between the anatomical and post-malreduction groups (P = 0.038) in coronal (medial-lateral) displacement.ConclusionsMalreduction in different conditions does affect the stability of the syndesmotic fixation. The result of the study may reveal the biomechanical mechanism of poor clinical outcome in syndesmosis malreduction patients and pathological displacement patterns of the ankle under syndesmotic malreduction conditions.Level of evidenceIII
Highlights
This study aims to investigate the malreduction of syndesmosis and its effects on stability
Torque resistance and fibular rotation among the different groups under internal rotation and external rotation force There were significant differences in torque resistance and fibular rotation angle between the intact and postmalreduction groups, and the foot was under internal load
A significant difference in torque resistance was found between the intact and ant-malreduction groups, while the foot was under external load (3.70 ± 0.57 vs. 3.02 ± 0.41 Nm, t = 2.380, P = 0.039)
Summary
This study aims to investigate the malreduction of syndesmosis and its effects on stability. Anatomical reduction and rigid fixation of both the fracture and syndesmosis should be performed to acquire a good clinical result. It is difficult to accurately judge the reduction of the syndesmosis during surgery. Due to the improper position of the syndesmotic screw or abnormal placement of the reduction forceps, syndesmosis may be fixed at the non-anatomical positon, which normally leads to malreduction. The concept of syndesmotic malreduction was reported by Gardner et al. Bai et al Journal of Orthopaedic Surgery and Research (2020) 15:64 mechanical instability that might affect ankle function? In order to further test this question, a biomechanical study was performed by directly investigating the mechanical relationship between syndesmotic malreduction and its stability Bai et al Journal of Orthopaedic Surgery and Research (2020) 15:64 mechanical instability that might affect ankle function? In order to further test this question, a biomechanical study was performed by directly investigating the mechanical relationship between syndesmotic malreduction and its stability
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