Fractures of the malleolus with syndesmotic injury : a challenge to diagnosis and treatment
Abstract
Fractures of the malleolus associated with syndesmotic injuries are common. Diagnosis of the syndesmotic injury often is missed and requires stress testing. An initial stable syndesmosis on x-ray may get displaced in later x-ray and a high suspicion Index can prevent one from missing this injury. Figure 1 and 2. Accurate reduction and stable fixation of the syndesmosis are critical to outcomes. Unstable syndesmosis is particularly prone to malreduction including translation, rotation, and overcompression. Knowledge of the technical details regarding intraoperative reduction methods and reduction assessment can minimize the risk of syndesmotic malreduction and improve patient outcomes.
Downloads
References
Hak DJ, Egol KA, Gardner MJ, Haskell A: The "not so simple" ankle fracture: Avoiding problems and pitfalls to improve patient outcomes. Instr Course Lect 2011;60:73-88.
Ebraheim NA, Lu J, Yang H, Rollins J: The fibular incisure of the tibia on CT scan: A cadaver study. Foot Ankle Int 1998;19(5): 318-321.
Beumer A, Valstar ER, Garling EH, et al: Kinematics of the distal tibiofibular syndesmosis: Radiostereometry in 11 normal ankles. Acta Orthop Scand 2003;74 (3):337-343.
Zalavras C, Thordarson D: Ankle syndesmotic injury. J Am Acad Orthop Surg 2007;15(6):330-339.
Young BH, Flanigan RM, DiGiovanni BF: Complications of ankle arthroscopy utilizing a contemporary noninvasive distraction technique. J Bone Joint Surg Am 2011;93(10):963-968.
Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG: Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int 2009;30 (5):419-426.
Marmor M, Hansen E, Han HK, Buckley J, Matityahu A: Limitations of standard fluoroscopy in detecting rotational malreduction of the syndesmosis in an ankle fracture model. Foot Ankle Int 2011; 32(6):616622.
Song DJ, Lanzi JT, Groth AT, et al: The effect of syndesmosis screw removal on the reduction of the distal tibiofibular joint: A prospective radiographic study. Foot Ankle Int 2014;35(6):543-548.
The entire contents of the Orthopaedic Journal of Madhya Pradesh Chapter are protected under Indian and International copyrights. Orthopaedic Journal of Madhya Pradesh Chapter allow authors to retain the copyrights of their papers without restrictions, Authors grant the publisher the right of exclusive publication. The Journal then grants to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, perform and display the work publicly and to make and distribute derivative works in any digital medium for any reasonable non-commercial purpose, subject to proper attribution of authorship. The journal also grants the right to make numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Non-commercial share alike 4.0 International Public License.