Comparative CT Study on Syndesmosis Mobility after Static or Dynamic Fixation for Ankle Fractures with Syndesmotic Rupture: A Pilot Study | ||
| The Archives of Bone and Joint Surgery | ||
| مقاله 8، دوره 10، شماره 8، آبان 2022، صفحه 702-711 اصل مقاله (1.08 M) | ||
| نوع مقاله: RESEARCH PAPER | ||
| شناسه دیجیتال (DOI): 10.22038/abjs.2022.61845.3020 | ||
| نویسندگان | ||
| Aitor Ibarzabal-Gil1؛ Elena Galvez-Srvent2؛ Jose M. Martinez-Diez1؛ Javier Pallares-Sanmartí1؛ Carlos Kalbakdij-Sanchez1؛ Sarah Mills1؛ Juan C. Rubio-Suarez1؛ Enrique Gil-Garay1؛ E. Carlos RODRIGUEZ-MERCHAN* 3 | ||
| 1Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain | ||
| 2Department of Orthopedic Surgery, Infanta Elena University Hospital, Valdemoro, Madrid, Spain | ||
| 3Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research, IdiPAZ (La Paz University Hospital, Autonomous University of Madrid), Madrid, Spain | ||
| چکیده | ||
| Background: The objective of this prospective randomized pilot study is to compare, by computed tomography (CT), the mobility of syndesmosis after static fixation (SF) or dynamic fixation (DF) in ankle fractures with syndesmotic rupture (AFSR) in adults, and to compare this mobility with that of healthy ankles. Methods: Forty-two patients with an AFSR were randomized to 2 groups: SF (N=21) or DF (N=21). Seven patients were lost to follow-up. Ultimately, 35 patients (SF, N=20; DF, N=15) were analyzed. The clinical results were assessed with the American Orthopedic Foot and Ankle Society scale. To assess syndesmosis mobility, CT in 30° of plantar flexion (PFlex) and 20° of dorsal flexion (DFlex) was performed on both ankles one year after the fracture. Four parameters were measured: anterior tibiofibular distance, posterior tibiofibular posterior distance, angle of fibular rotation (AFR), and anteroposterior fibular translation. Results: The AFR between DFlex and PFlex was more similar to the non-affected side in the DF group. The other three parameters showed no statistical differences between types of fixation. The mean loss of AFR compared with the non-affected side was 1.2° in the SF group and 0.1° in the DF group. No clinical differences between the SF group and the DF group were found. No correlation between clinical and radiological results was observed. Conclusions: The AFR was more similar to the non-affected side in the DF group. However, this finding did not correlate with a better clinical result. Keywords: Ankle; Fracture; Syndesmosis mobility; Static fixation; Dynamic fixation; CT scan Level of Evidence II: Prospective cohort study. | ||
| کلیدواژهها | ||
| Ankle؛ CT scan؛ Dynamic fixation؛ Fracture؛ Static fixation؛ Syndesmosis mobility | ||
| مراجع | ||
|
1. Kellett JJ. The clinical features of ankle syndesmosis injuries: a general review.Clin J Sport Med. 2011; 21(6):524-9. 2. Purvis GD. Displaced, unstable ankle fractures: classification, incidence, and management of a consecutive series.Clin Orthop Relat Res. 1982; 165:91-8. 3. Scheer RC, Newman JM, Zhou JJ, Oommen AJ, Naziri Q, Shah NV, et al. Ankle fracture epidemiology in the United States: patient-related trends and mechanisms of injury. J Foot Ankle Surg. 2020; 59(3):479-83. 4. Rammelt S, Zwipp H, Grass R. Injuries to the distal tibiofibular syndesmosis: an evidence-based approach to acute and chronic lesions. Foot Ankle Clin. 2008; 13(4):611-33. 5. Jensen SL, Andresen BK, Mencke S, Nielsen PT. Epidemiology of ankle fractures. A prospective 1. Kellett JJ. The clinical features of ankle syndesmosis injuries: a general review.Clin J Sport Med. 2011; 21(6):524-9. 2. Purvis GD. Displaced, unstable ankle fractures: classification, incidence, and management of a consecutive series.Clin Orthop Relat Res. 1982; 165:91-8. 3. Scheer RC, Newman JM, Zhou JJ, Oommen AJ, Naziri Q, Shah NV, et al. Ankle fracture epidemiology in the United States: patient-related trends and mechanisms of injury. J Foot Ankle Surg. 2020; 59(3):479-83. 4. Rammelt S, Zwipp H, Grass R. Injuries to the distal tibiofibular syndesmosis: an evidence-based approach to acute and chronic lesions. Foot Ankle Clin. 2008; 13(4):611-33. 5. Jensen SL, Andresen BK, Mencke S, Nielsen PT. Epidemiology of ankle fractures. A prospective population-based study of 212 cases in Aalborg, Denmark. Acta Orthop Scand. 1998; 69(1):48-50. 6. van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001; 29(6):517-22. 7. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures—an increasing problem? Acta Orthop Scand. 1998; 69(1):43-7. 8. Elgafy H, Semaan HB, Blessinger B, Wassef A, Ebraheim NA. Computed tomography of normal distal tibiofibular syndesmosis. Skeletal Radiol. 2010; 39(6):559-64. 9. Endo J, Yamaguchi S, Saito M, Morikawa T, Akagi R, Sasho T. Changes in the syndesmotic reduction after syndesmotic screw fixation for ankle malleolar fractures: One-year longitudinal evaluations using computer tomography. Injury .2016; 47(10):2360-5. 10.Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. 2012; 26(7):439-43. 11.Peter RE, Harrington RM, Henley MB, Tencer AF. Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques. J Orthop Trauma. 1994; 8(3):215-9. 12.Wang C, Ma X, Wang X, Huang J, Zhang C, Chen L. Internal fixation of distal tibiofibular syndesmotic injuries: a systematic review with meta-analysis. Int Orthop. 2013; 37(9):1755-63. 13.Krähenbühl N, Weinberg MW, Hintermann B, Haller JM, Saltzman CL, Barg A. Surgical outcome in chronic syndesmotic injury: a systematic literature review. Foot Ankle Surg. 2019; 25(5):691-7. 14.Nousiainen MT, McConnell AJ, Zdero R, McKee MD, Bhandari M, Schemitsch EH. The influence of the number of cortices of screw purchase and ankle position in Weber C ankle fracture fixation. J Orthop Trauma. 2008; 22(7):473-8. 15.McKenzie AC, Hesselholt KE, Larsen ML, Schmal H. A systematic review and meta-analysis on treatment of ankle fractures with syndesmotic rupture: suturebutton fixation versus cortical screw fixation. J Foot Ankle Surg. 2019;58(5):946-53. 16.Xie L, Xie H, Wang J, Chen C, Zhang C, Chen H, et al. Comparison of suture button fixation and syndesmotic screw fixation in the treatment of distal tibiofibular syndesmosis injury: A systematic review and metaanalysis. Int J Surg. 2018; 60:120-31. 17.Zhang P, Liang Y, He J, Fang Y, Chen P, Wang J. A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury. BMC Musculoskelet Disord. 2017; 18(1):286. 18.Lauge-Hansen N. Fractures of the ankle: II. Combined experimental-surgical and experimentalroentgenologic investigations. Arch Surg. 1950; 60(5):957-85. 19.Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994; 15(7):349-53. 20.Mousavian A, Shakoor D, Hafezi-Nejad N, Haj-Mirzaian A, de Cesar Netto C, Orapin J, et al. Tibiofibular syndesmosis in asymptomatic ankles: initial kinematic analysis using four-dimensional CT.Clinical Radiol. 2019;74(7):571.e1-571.e8. 21.Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012; 36(6):1199-206. 22.Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005; 431:207-12. 23.Stiene A, Renner CE, Chen T, Liu J, Ebraheim NA. Distal tibiofibular syndesmosis dysfunction: a systematic literature review of dynamic versus static fixation over the last 10 years. Foot Ankle Surg. 2019; 58(2):320-7. 24.Kortekangas T, Savola O, Flinkkilä T, Lepojärvi S, Nortunen S, Ohtonen P, et al. A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography. Injury. 2015; 46(6):1119-26. 25.Beumer A, van Hemert WLW, Niesing R, Entius CAC, Ginai AZ, Mulder PGH, et al. Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res. 2004; 423:227-34. 26.Pneumaticos SG, Noble PC, Chatziioannou SN, Trevino SG. The effects of rotation on radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle Int. 2002;23(2):107-11. 27.Beumer A, Valstar ER, Garling EH, Niesing R, Ranstam J, Löfvenberg R, et al. Kinematics of the distal tibiofibular syndesmosis: radiostereometry in 11 normal ankles. Acta Orthop Scand. 2003; 74(3):337-43. 28.Osgood GM, Shakoor D, Orapin J, Qin J, Khodarahmi I, Thawait GK, et al. Reliability of distal tibio-fibular syndesmotic instability measurements using weightbearing and non-weightbearing cone-beam CT. Foot Ankle Surg. 2019;25(6):771-81. 29.Shakoor D, Osgood GM, Brehler M, Zbijewski WB, de Cesar Netto C, Shafiq B, et al. Cone-beam CT measurements of distal tibio-fibular syndesmosis in asymptomatic uninjured ankles: does weight-bearing matter? Skeletal Radiol. 2019; 48(4):583-94. 30.Nault M-L, Hébert-Davies J, Laflamme G-Y, Leduc S. CT scan assessment of the syndesmosis: a new reproducible method. J Orthop Trauma. 2013; 27(11):638-41. 31.Warner SJ, Fabricant PD, Garner MR, Schottel PC, Helfet DL, Lorich DG. The measurement and clinical importance of syndesmotic reduction after operative fixation of rotational ankle fractures. J Bone Joint Surg Am. 2015; 97(23):1935-44. 32.Michelson JD, Helgemo Jr SL. Kinematics of the axially loaded ankle. Foot Ankle Int. 1995; 16(9):577-82. 33.Kohake MBJ, Wiebking U, O’Loughlin PF, Krettek C, Gaulke R. Mid- to long-term outcomes after Weber B-type ankle fractures with and without syndesmotic rupture. In Vivo. 2019;33(1):255-61. 34.Gräff P, Alanazi S, Alazzawi S, Weber-Spickschen S, Krettek C, Dratzidis A, et al. Screw fixation for syndesmotic injury is stronger and provides more contact area of the joint surface than TightRope®: A biomechanical study. Technol Health Care. 2020;28(5):533-9. 35.Longo UG, Loppini M, Fumo C, Lanotte A, Trovato U, Risi Ambrogioni L, et al. Deep deltoid ligament injury is related to rotational instability of the ankle joint: a biomechanical study. Knee Surg Sports Traumatol Arthrosc .2021; 29(5):1577-83 | ||
|
آمار تعداد مشاهده مقاله: 512 تعداد دریافت فایل اصل مقاله: 412 |
||