Abstract
The purpose of this study is to evaluate the reasonable parameters to predict unstable syndesmotic injuries in ankle fractures. Seventy consecutive patients who underwent preoperative bilateral computed tomography (CT) scans were enrolled. Group A consisted of 20 patients intraoperatively diagnosed with syndesmotic injuries according to an intraoperative stress test and group B consisted of 50 patients who had nosyndesmotic injuries. The tibiofibular overlap (TFO) and tibiofibular clear space (TFCS) were measured using preoperative ankle radiographs. Measuring the anterior fibular distance (AFD), posterior fibular distance (PFD), anterior translation distance (AT), fibular diastasis (FD), anterior-posterior translation (APT), fibular length (FL), and surface area of syndesmosis (SAS) 1.0 and 1.5 which 1.0 cm and 1.5 cm above the tibial plafond was done via preoperative CT scan. The ratio of measurements (Injured/Intact) of the TFO, PFD, APD, and SAS 1.0 showed statistically significant differences. The researchers identified the SAS 1.0 as the most reasonable parameter to predict transfixation using receiver-operating characteristic (ROC) curve analysis. The SAS 1.0 is most valid parameter to predict syndesmotic injuries in this study and these results show that performing a bilateral CT scan on an ankle fracture may provide substantial information in measuring valid parameters.
Highlights
In unstable ankle fractures with syndesmotic injuries, an open reduction and internal fixation of fracture site and stabilization of syndesmosis are required in an effort to minimize the risk of posttraumatic arthritis [1]
The present study reviewed 103 consecutive patients with ankle fractures who took preoperative bilateral computed tomography (CT) scans and were operatively treated between 2008 and 2017
The results of this study revealed that tibiofibular overlap (TFO), posterior fibular distance (PFD), anterior-posterior translation (APT), and surface area of syndesmosis (SAS) 1.0 were significantly reasonable parameters in judging syndesmotic injury
Summary
In unstable ankle fractures with syndesmotic injuries, an open reduction and internal fixation of fracture site and stabilization of syndesmosis are required in an effort to minimize the risk of posttraumatic arthritis [1]. Syndesmotic injuries in ankle fractures are challenging to treat in particular, not to mention relatively common in fields that require intense physical activity [2,3,4]. Fractures around the tibia and the fibular can result in various clinical features that complicate classic radiography diagnosis. An intraoperative stress test, such as an external rotation test or hook test [8,9], can be used as more accurate dynamic test tool. This has its limitations, as it requires anesthesia, preventing preoperative information from being provided
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