SLR - May 2013 - Olga Gonzalez
Reference: Summers HD, Sinclair MK, Stover MD. A reliable method for Intraoperative Evaluation of Syndesmotic Reduction. J Orthop Trauma 2013 Apr;27(4):196-200.
Scientific Literature Review
Reviewed by: Olga Gonzalez, DPM
Residency Program: Temple University Hospital, Philadelphia, PA
Podiatric Relevance: Syndesmotic reduction and alignment can be difficult to assess intraoperatively and is typically confirmed postoperatively. There are few methods that have been described in the literature to confirm proper reduction intraoperatively. This article provides an adequate measurement of the fibular sagittal position in the tibial incisura comparing contralateral radiographs, providing reproducible results without the need of intraoperative computer tomography (CT).
Methods: A prospective case series over a two year period included 18 patients with ankle fractures and suspected syndesmotic injuries. Ankle mortise and lateral images of the uninjured side were obtained and used to measure sagittal placement of the fibula in the tibial incisura by measuring the distance of the anterior or posterior border of the fibula with the anterior or posterior border of the tibia. Cotton test and/or external rotation distraction tests were performed to confirm the syndesmotic injury. The same radiographic measurements were performed on the injured side and care was taken to match the same position of the uninjured side. Intraoperative CT images were used to verify the reduction.
Results: Seventeen of the 18 syndesmotic injuries were properly aligned based on the intraoperative CT evaluation. The one patient that had a syndesmotic malalignment had a mal-reduced fibular fracture and underwent correction of the fibular fracture reduction with consequently syndesmotic alignment.
Conclusions: Adequate syndesmotic alignment is critical to reduce arthritis and instability. Proper lateral images of the contralateral side comparing sagittal fibular position can provide a reliable template to obtain intraoperative syndesmotic accuracy without the need of other radiographic modalities.