Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries

Franke, Jochen; von Recum, Jan; Suda, Arnold J.; Grützner, Paul Alfred; Wendl, Klaus

Affiliations

¹BG Trauma Center Ludwigshafen at Heidelberg University Hospital

²MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Strasse 13, D-67071 Ludwigshafen, Germany

Abstract

Backround: Acute unstable syndesmotic ankle injuries are treated primarily by reduction and stabilization with a syndesmotic screw. Examination with fluoroscopy or standard radiographs may not provide reliable information about the quality of the reduction. There is evidence that intraoperative three-dimensional imaging can demonstrate a large proportion of malreductions. The aim of this study was to determine whether intraoperative three-dimensional imaging improves the detection of inadequate positioning of the distal aspect of the fibula in the tibiofibular incisura after syndesmotic screw insertion compared with the findings on standard intraoperative fluoroscopy.

Methods: Of 2286 ankle fractures treated operatively from August 2001 to February 2011, 251 consecutive cases (11%) were identified in a retrospective chart review. All had an unstable syndesmosis and underwent syndesmosis stabilization on the basis of an intraoperative hook test. After fluoroscopy, an intraoperative three-dimensional scan was performed. The result of this scan was documented by the surgeon and analyzed retrospectively with regard to the incidence and nature of the need for intraoperative revisions.

Results: The intraoperative three-dimensional scan altered the surgical outcome in eighty-two ankles (32.7%). In most ankles (seventy-seven; 30.7%), the reduction was improved, with the most common improvement being the alignment of the fibula in the tibiofibular incisura in sixty-four patients (25.5%) followed by correction of the fracture reduction in thirteen patients (5.2%). The other five alterations involved implant corrections. The most common malpositions requiring correction after insertion of a positioning screw, with or without additional fixation, were anterior displacement and internal rotation of the distal aspect of the fibula.

Conclusions: Following open reduction and internal fixation of an ankle fracture, the correct position of the syndesmosis cannot be evaluated reliably with use of conventional radiographs or intraoperative fluoroscopy. In view of the high proportion of positive findings in this study, we believe that any treatment of a syndesmotic injury should include intraoperative three-dimensional imaging or at least a postoperative computed tomography scan.

Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Links

DOI: 10.2106/JBJS.K.01122

PubMed: 22854991

WoS: 000306939000006

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Cited By (1)

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2016	Lareau CR, Hsu AR, Cohen BE. Acute syndesmotic injuries. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:265-277.