The distal tibiofibular syndesmosis during passive foot flexion:​ RSA-based study on intact, ligament injured and screw fixed cadaver specimens

Bragonzoni, Laura; Russo, Alessandro; Girolami, Mauro; Albisinni, Ugo; Visani, Andrea; Mazzotti, Nicoletta; Marcacci, Maurilio

Affiliations

¹Biomechanics Laboratory, Centro di Ricerca “Codivilla-Putti”, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy

²Department of Orthopaedic, Istituti Ortopedici Rizzoli, Via Pupilli 1, 40136 Bologna, Italy

³Department of Radiology, Istituti Ortopedici Rizzoli, Via Pupilli 1, 40136 Bologna, Italy

Abstract and keywords

Introduction: The aim of the study was to investigate the kinematics of the distal tibiofibular syndesmosis in intact and ligament injured ankles and to assess how effective is the syndesmotic screw in restraining mortise width variations during passive foot flexion.

Materials and methods: The trials were carried out on seven fresh frozen cadaver specimens. The distal tibiofibular syndesmosis widening was investigated using Roentgen stereophotogrammetric analysis, in intact and ligament injured ankles and after the fixation of the syndesmotic screw. The AO-ASIF recommendations were followed for screw implant.

Results: Injury to the syndesmotic and deltoid ligaments of the ankle did not result in a significant variation of the syndesmosis behavior during passive foot flexion. The 4.5-mm diameter cortical screw used in this study proved effective in restraining mortise width variation during foot flexion. The recorded mortise widening in the flexion arc extending from the neutral to the maximally dorsiflexed position was negligible in intact and ligament injured joints.

Conclusion: The result does not endorse the recommendation of placing the foot in full dorsal flexion during screw implantation. The choice of screw fixation as a treatment for ankle syndesmosis disruption should be carefully evaluated.

Keywords: Syndesmosis; Screw; RSA; Tibiofibular; Ankle

Links

DOI: 10.1007/s00402-006-0131-8

PubMed: 16568290

WoS: 000238530700003

History

Received: 2004-11-29

Online: 2006-03-28

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Cited By (6)

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2013	Hunt KJ. Syndesmosis injuries. Curr Rev Musculoskel Med. December 2013;6(4):304-312.
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2011	Schepers T. To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg. July 2011;131(7):879-883.
2012	Markolf KL, Jackson S, McAllister DR. Force and displacement measurements of the distal fibula during simulated ankle loading tests for high ankle sprains. Foot Ankle Int. September 2012;33(9):779-786.
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2010	Miller AN, Paul O, Boraiah S, Parker RJ, Helfet DL, Lorich DG. Functional outcomes after syndesmotic screw fixation and removal. J Orthop Trauma. January 2010;24(1):12-16.