Intraoperative Diagnosis of Syndesmosis Injuries in External Rotation Ankle Fractures
OBJECTIVE:This study was designed to compare intraoperative fluoroscopic stress testing, static radiographs, and biomechanical criteria for the diagnosis of distal tibiofibular syndesmotic instability associated with external rotation type ankle fractures. DESIGN:Prospective, consecutive series. SET...
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| Veröffentlicht in: | Journal of orthopaedic trauma 2005-10, Vol.19 (9), p.604-609 |
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| creator | Jenkinson, Richard J Sanders, David W Macleod, Mark D Domonkos, Andrea Lydestadt, Jeanette |
| description | OBJECTIVE:This study was designed to compare intraoperative fluoroscopic stress testing, static radiographs, and biomechanical criteria for the diagnosis of distal tibiofibular syndesmotic instability associated with external rotation type ankle fractures.
DESIGN:Prospective, consecutive series.
SETTING:Academic level 1 trauma center.
PATIENTS/PARTICIPANTS:Thirty-eight skeletally mature patients with unstable unilateral external rotation ankle fractures were prospectively recruited.
INTERVENTION:Before surgery, the treating surgeon detailed the operative treatment plan, including need for syndesmotic fixation. In pronation-external rotation injuries, biomechanical criteria were applied to predict syndesmotic instability. Ankles were examined using intraoperative fluoroscopic external rotation stress tests. The contralateral uninjured limb was used as a control. A 7.2-Nm force was applied for the external rotation stress examination. Stress testing was performed after lateral malleolar fixation and repeated after medial and syndesmotic fixation.
MAIN OUTCOME MEASURES:The incidence of syndesmotic instability was determined based on radiographic clear space measurements and compared with previously published criteria.
RESULTS:Intraoperative fluoroscopy detected unpredicted syndesmotic instability in 37% of ankles. In supination-external rotation (OTA 44B) injuries, unpredicted syndesmosis instability was found in 10 of 30 patients (33%). In pronation-external rotation injuries (OTA 44C), 4 of 7 patients (57%) were associated with syndesmosis disruption not predicted by biomechanical criteria. In bimalleolar fractures, syndesmosis fixation improved stability compared with rigid bimalleolar fixation alone (P < 0.01).
CONCLUSIONS:Preoperative radiographs and biomechanical criteria are unable to routinely predict the presence or absence of syndesmosis instability. Rigid bimalleolar fixation was frequently not sufficient to stabilize syndesmotic disruption. Intraoperative stress fluoroscopy is a valuable tool for detection of unstable syndesmotic injuries. |
| doi_str_mv | 10.1097/01.bot.0000177114.13263.12 |
| format | Article |
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DESIGN:Prospective, consecutive series.
SETTING:Academic level 1 trauma center.
PATIENTS/PARTICIPANTS:Thirty-eight skeletally mature patients with unstable unilateral external rotation ankle fractures were prospectively recruited.
INTERVENTION:Before surgery, the treating surgeon detailed the operative treatment plan, including need for syndesmotic fixation. In pronation-external rotation injuries, biomechanical criteria were applied to predict syndesmotic instability. Ankles were examined using intraoperative fluoroscopic external rotation stress tests. The contralateral uninjured limb was used as a control. A 7.2-Nm force was applied for the external rotation stress examination. Stress testing was performed after lateral malleolar fixation and repeated after medial and syndesmotic fixation.
MAIN OUTCOME MEASURES:The incidence of syndesmotic instability was determined based on radiographic clear space measurements and compared with previously published criteria.
RESULTS:Intraoperative fluoroscopy detected unpredicted syndesmotic instability in 37% of ankles. In supination-external rotation (OTA 44B) injuries, unpredicted syndesmosis instability was found in 10 of 30 patients (33%). In pronation-external rotation injuries (OTA 44C), 4 of 7 patients (57%) were associated with syndesmosis disruption not predicted by biomechanical criteria. In bimalleolar fractures, syndesmosis fixation improved stability compared with rigid bimalleolar fixation alone (P < 0.01).
CONCLUSIONS:Preoperative radiographs and biomechanical criteria are unable to routinely predict the presence or absence of syndesmosis instability. Rigid bimalleolar fixation was frequently not sufficient to stabilize syndesmotic disruption. Intraoperative stress fluoroscopy is a valuable tool for detection of unstable syndesmotic injuries.</description><identifier>ISSN: 0890-5339</identifier><identifier>EISSN: 1531-2291</identifier><identifier>DOI: 10.1097/01.bot.0000177114.13263.12</identifier><identifier>PMID: 16247304</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ankle Injuries - diagnostic imaging ; Ankle Injuries - surgery ; Biological and medical sciences ; Diseases of the osteoarticular system ; Female ; Fractures, Bone - diagnostic imaging ; Fractures, Bone - surgery ; Humans ; Injuries of the limb. Injuries of the spine ; Intraoperative Care - methods ; Ligaments, Articular - injuries ; Ligaments, Articular - surgery ; Male ; Medical sciences ; Middle Aged ; Physical Examination - methods ; Prognosis ; Radiography ; Reproducibility of Results ; Rotation ; Sensitivity and Specificity ; Surgery, Computer-Assisted - methods ; Traumas. Diseases due to physical agents</subject><ispartof>Journal of orthopaedic trauma, 2005-10, Vol.19 (9), p.604-609</ispartof><rights>2005 Lippincott Williams & Wilkins, Inc.</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3074-3c43c3327065daee3e0fd2274fd3233e42cc8c00e293dc2d9479f4a2a5b1c21c3</citedby><cites>FETCH-LOGICAL-c3074-3c43c3327065daee3e0fd2274fd3233e42cc8c00e293dc2d9479f4a2a5b1c21c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17279468$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16247304$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jenkinson, Richard J</creatorcontrib><creatorcontrib>Sanders, David W</creatorcontrib><creatorcontrib>Macleod, Mark D</creatorcontrib><creatorcontrib>Domonkos, Andrea</creatorcontrib><creatorcontrib>Lydestadt, Jeanette</creatorcontrib><title>Intraoperative Diagnosis of Syndesmosis Injuries in External Rotation Ankle Fractures</title><title>Journal of orthopaedic trauma</title><addtitle>J Orthop Trauma</addtitle><description>OBJECTIVE:This study was designed to compare intraoperative fluoroscopic stress testing, static radiographs, and biomechanical criteria for the diagnosis of distal tibiofibular syndesmotic instability associated with external rotation type ankle fractures.
DESIGN:Prospective, consecutive series.
SETTING:Academic level 1 trauma center.
PATIENTS/PARTICIPANTS:Thirty-eight skeletally mature patients with unstable unilateral external rotation ankle fractures were prospectively recruited.
INTERVENTION:Before surgery, the treating surgeon detailed the operative treatment plan, including need for syndesmotic fixation. In pronation-external rotation injuries, biomechanical criteria were applied to predict syndesmotic instability. Ankles were examined using intraoperative fluoroscopic external rotation stress tests. The contralateral uninjured limb was used as a control. A 7.2-Nm force was applied for the external rotation stress examination. Stress testing was performed after lateral malleolar fixation and repeated after medial and syndesmotic fixation.
MAIN OUTCOME MEASURES:The incidence of syndesmotic instability was determined based on radiographic clear space measurements and compared with previously published criteria.
RESULTS:Intraoperative fluoroscopy detected unpredicted syndesmotic instability in 37% of ankles. In supination-external rotation (OTA 44B) injuries, unpredicted syndesmosis instability was found in 10 of 30 patients (33%). In pronation-external rotation injuries (OTA 44C), 4 of 7 patients (57%) were associated with syndesmosis disruption not predicted by biomechanical criteria. In bimalleolar fractures, syndesmosis fixation improved stability compared with rigid bimalleolar fixation alone (P < 0.01).
CONCLUSIONS:Preoperative radiographs and biomechanical criteria are unable to routinely predict the presence or absence of syndesmosis instability. Rigid bimalleolar fixation was frequently not sufficient to stabilize syndesmotic disruption. Intraoperative stress fluoroscopy is a valuable tool for detection of unstable syndesmotic injuries.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ankle Injuries - diagnostic imaging</subject><subject>Ankle Injuries - surgery</subject><subject>Biological and medical sciences</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Fractures, Bone - surgery</subject><subject>Humans</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Intraoperative Care - methods</subject><subject>Ligaments, Articular - injuries</subject><subject>Ligaments, Articular - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Physical Examination - methods</subject><subject>Prognosis</subject><subject>Radiography</subject><subject>Reproducibility of Results</subject><subject>Rotation</subject><subject>Sensitivity and Specificity</subject><subject>Surgery, Computer-Assisted - methods</subject><subject>Traumas. Diseases due to physical agents</subject><issn>0890-5339</issn><issn>1531-2291</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkcFu1DAQhi0EokvhFVCEBLcEz9iJE25VaWGlSkhAz5bXmdC0Xnuxk5a-Pc7uSjsHj0b6_hnpM2MfgFfAO_WZQ7UJU8VzgVIAsgKBjagAX7AV1AJKxA5eshVvO17WQnRn7E1K95lvOeJrdgYNSiW4XLHbtZ-iCTuKZhofqfg6mj8-pDEVYSh-Pfue0nY_rv39HEdKxeiLq38TRW9c8TNMORZ8ceEfHBXX0dhpjpTesleDcYneHfs5u72--n35vbz58W19eXFTWsGVLIWVwgqBijd1b4gE8aFHVHLoBQpBEq1tLeeEnegt9p1U3SANmnoDFsGKc_bpsHcXw9-Z0qS3Y7LknPEU5qSbVmGnuMrglwNoY0gp0qB3cdya-KyB60Wq5qCzVH2SqvdSNWAOvz9emTdb6k_Ro8UMfDwCJlnjhmi8HdOJU6g62bSZkwfuKbhsMD24-YmiviPjprv96RqW31v6MpXLI8V_joGQsg</recordid><startdate>200510</startdate><enddate>200510</enddate><creator>Jenkinson, Richard J</creator><creator>Sanders, David W</creator><creator>Macleod, Mark D</creator><creator>Domonkos, Andrea</creator><creator>Lydestadt, Jeanette</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200510</creationdate><title>Intraoperative Diagnosis of Syndesmosis Injuries in External Rotation Ankle Fractures</title><author>Jenkinson, Richard J ; Sanders, David W ; Macleod, Mark D ; Domonkos, Andrea ; Lydestadt, Jeanette</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3074-3c43c3327065daee3e0fd2274fd3233e42cc8c00e293dc2d9479f4a2a5b1c21c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ankle Injuries - diagnostic imaging</topic><topic>Ankle Injuries - surgery</topic><topic>Biological and medical sciences</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Fractures, Bone - diagnostic imaging</topic><topic>Fractures, Bone - surgery</topic><topic>Humans</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Intraoperative Care - methods</topic><topic>Ligaments, Articular - injuries</topic><topic>Ligaments, Articular - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Physical Examination - methods</topic><topic>Prognosis</topic><topic>Radiography</topic><topic>Reproducibility of Results</topic><topic>Rotation</topic><topic>Sensitivity and Specificity</topic><topic>Surgery, Computer-Assisted - methods</topic><topic>Traumas. Diseases due to physical agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jenkinson, Richard J</creatorcontrib><creatorcontrib>Sanders, David W</creatorcontrib><creatorcontrib>Macleod, Mark D</creatorcontrib><creatorcontrib>Domonkos, Andrea</creatorcontrib><creatorcontrib>Lydestadt, Jeanette</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of orthopaedic trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jenkinson, Richard J</au><au>Sanders, David W</au><au>Macleod, Mark D</au><au>Domonkos, Andrea</au><au>Lydestadt, Jeanette</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative Diagnosis of Syndesmosis Injuries in External Rotation Ankle Fractures</atitle><jtitle>Journal of orthopaedic trauma</jtitle><addtitle>J Orthop Trauma</addtitle><date>2005-10</date><risdate>2005</risdate><volume>19</volume><issue>9</issue><spage>604</spage><epage>609</epage><pages>604-609</pages><issn>0890-5339</issn><eissn>1531-2291</eissn><abstract>OBJECTIVE:This study was designed to compare intraoperative fluoroscopic stress testing, static radiographs, and biomechanical criteria for the diagnosis of distal tibiofibular syndesmotic instability associated with external rotation type ankle fractures.
DESIGN:Prospective, consecutive series.
SETTING:Academic level 1 trauma center.
PATIENTS/PARTICIPANTS:Thirty-eight skeletally mature patients with unstable unilateral external rotation ankle fractures were prospectively recruited.
INTERVENTION:Before surgery, the treating surgeon detailed the operative treatment plan, including need for syndesmotic fixation. In pronation-external rotation injuries, biomechanical criteria were applied to predict syndesmotic instability. Ankles were examined using intraoperative fluoroscopic external rotation stress tests. The contralateral uninjured limb was used as a control. A 7.2-Nm force was applied for the external rotation stress examination. Stress testing was performed after lateral malleolar fixation and repeated after medial and syndesmotic fixation.
MAIN OUTCOME MEASURES:The incidence of syndesmotic instability was determined based on radiographic clear space measurements and compared with previously published criteria.
RESULTS:Intraoperative fluoroscopy detected unpredicted syndesmotic instability in 37% of ankles. In supination-external rotation (OTA 44B) injuries, unpredicted syndesmosis instability was found in 10 of 30 patients (33%). In pronation-external rotation injuries (OTA 44C), 4 of 7 patients (57%) were associated with syndesmosis disruption not predicted by biomechanical criteria. In bimalleolar fractures, syndesmosis fixation improved stability compared with rigid bimalleolar fixation alone (P < 0.01).
CONCLUSIONS:Preoperative radiographs and biomechanical criteria are unable to routinely predict the presence or absence of syndesmosis instability. Rigid bimalleolar fixation was frequently not sufficient to stabilize syndesmotic disruption. Intraoperative stress fluoroscopy is a valuable tool for detection of unstable syndesmotic injuries.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>16247304</pmid><doi>10.1097/01.bot.0000177114.13263.12</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Ankle Injuries - diagnostic imaging Ankle Injuries - surgery Biological and medical sciences Diseases of the osteoarticular system Female Fractures, Bone - diagnostic imaging Fractures, Bone - surgery Humans Injuries of the limb. Injuries of the spine Intraoperative Care - methods Ligaments, Articular - injuries Ligaments, Articular - surgery Male Medical sciences Middle Aged Physical Examination - methods Prognosis Radiography Reproducibility of Results Rotation Sensitivity and Specificity Surgery, Computer-Assisted - methods Traumas. Diseases due to physical agents |
| title | Intraoperative Diagnosis of Syndesmosis Injuries in External Rotation Ankle Fractures |
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