Validation of a new method for evaluation of syndesmotic injuries of the ankle
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ORIGINAL PAPER
Validation of a new method for evaluation of syndesmotic injuries of the ankle Annette B. Ahrberg 1 Ulrich J. Spiegl 1
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Robert Hennings 1
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Nikolaus von Dercks 2 & Pierre Hepp 1
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Christoph Josten 1
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Received: 22 March 2020 / Accepted: 12 May 2020 # SICOT aisbl 2020
Abstract Purpose To define a new parameter in CT that could make imaging of the contralateral ankle dispensable evaluating the position of the fibula after syndesmotic injury. Methods Thirty bilateral CTs of 30 patients were included. Five parameters were defined in axial CT for the injured (_inju) and uninjured (_unin) ankle. Reproducibility was examined for inter-observer and intra-observer reliability. Comparisons for all parameters were performed between the CT scans of both ankles. Results All measurements had a high agreement for the inter-observer and intra-observer correlation coefficients. A large interindividual variance could be found between all parameters. If the difference of the anterior tibiofibular distance antTFD_unin and antTFD_inju was less than 2 mm, there was a strong significant pairwise correlation between all parameters between both sides. Conclusion Bilateral CT is still to be recommended, as it is the only way to exactly assess anterior posterior reduction of the fibula. Keywords Syndesmosis . Ankle . Screw . Suture-button . Computed tomography
Introduction Syndesmotic injuries are commonly associated with ankle fractures ranging between 10 and 45% [1, 2]. The correct reduction of the fibula in the incisura fibularis tibiae is the key criterion for long-term results in ankle fractures with syndesmotic injuries, making this a question of high clinical importance [3–6]. As conventional radiography has been proven to be unreliable to rule out malpositioning of the fibula, post- or intra-operative computed tomography (CT) is the only way to evaluate the position of the fibula in the incisura fibularis [5, 7–10]. Thus, bilateral CT control after implantation of a syndesmotic screw or a suture-button device has become a highly recommended procedure in ankle fracture treatment [3, 7–9, 11, 12]. Rotation, anterior-posterior translation, and shortening can be exactly assessed by bilateral CT * Annette B. Ahrberg [email protected] 1
Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
2
Medical Controlling, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
with diastases of 2 to 3 mm [3–5, 9]. Alternatively to postoperative scanning, intra-operative CT scans have been established in recent years. Usually, only the injured side is scanned intra-operatively, while most studies on distal tibiofibular measurements involve the uninjured side as well [12–15]. Thus, despite a high rate of studies conducted in this field, it yet remains unclear whether CT of the uninjured ankle is necessary for exact evaluation. We hypothesized that a newly defined parameter in CT imaging could make the CT of the contralateral an
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