What is the best approach to evaluating the reduction of the syndesmosis?

Objective: To evaluate the reliability, reproducibility, and intra- and interobserver correlation of eight tomographic methods used for assessing the reduction of the syndesmosis in high fractures of the fibula.Methods: A total of seven patients were selected. Eight tomographic methods of measurement were used in the axial plane of the ankle at 1cm proximal to the articular surface. Three orthopaedists from the surgical team were chosen to evaluate the reliability and reproducibility of the measurements. Preoperative and postoperative tomography was used, and measurements were made at two distinct time points, with an interval of 2 months between them. All correlations were assessed using the interclass correlation coefficient (ICC). Results: Method 3 (Zwipp) had ICC values >0.75 (excellent) in all measures by all examiners. Method 4 (Phisitkul) presented ICC values >0.95 (excellent) for the interobserver comparisons at the two time points. In the intraobserver comparison, method 4 had an ICC of 0.49 (satisfactory) in two preoperative evaluations, and the other comparisons presented an ICC >0.76 (excellent). Conclusion: The Zwipp and Phisitkul measurements presented high reliability and reproducibility and are useful for evaluating rotational andtranslational movements of the fibula at the level of the syndesmosis, respectively. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.