1
|
Ryan PM, Eakin JL, Goodrum JT. Subtle Syndesmotic Instability. J Am Acad Orthop Surg 2024; 32:719-727. [PMID: 38295390 DOI: 10.5435/jaaos-d-23-00707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Indexed: 02/02/2024] Open
Abstract
Latent or subtle syndesmotic instability is defined as an injury to the syndesmosis which is not apparent on static radiographs of the ankle. Syndesmotic injuries have also been referred to as high ankle sprains. Injury to the syndesmosis typically occurs with collision sports and often involves an external rotation force to the ankle. Diagnosis can be delayed because of negative initial imaging studies. Physical examination tests including the external rotation test, proximal squeeze test, and fibular shuck test can assist in the diagnosis. Advanced imaging modalities such as MRI and weight-bearing CT have been studied and can provide prognostic indications for management, although arthroscopic stress evaluation remains the benchmark for diagnosis. Both surgical and nonsurgical management techniques have been described, which can assist patients in returning to their preinjury level of function.
Collapse
Affiliation(s)
- Paul M Ryan
- From the Lake Tahoe Sports Medicine Fellowship, Department of Surgery, Barton Memorial Hospital, South Lake Tahoe, CA (Ryan, Eakin, Goodrum), University of Nevada, Reno School of Medicine, Reno, NV (Ryan), Uniformed Services University, Bethesda, MD (Ryan)
| | | | | |
Collapse
|
2
|
Kohler FC, Hallbauer J, Herrmann L, Ullrich BW, Biedermann U, Wildemann B, Hofmann GO, Ramm R, Lenz M, Marintschev I, Schenk P. Standardized analysis of syndesmosis stability in ankle trauma with an innovative syndesmosis-test-tool: a biomechanical study. Sci Rep 2024; 14:1659. [PMID: 38238396 PMCID: PMC10796637 DOI: 10.1038/s41598-024-51872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
When treating ankle fractures, the question of syndesmosis complex involvement often arises. So far, there is no standardized method to reliably detect syndesmosis injuries in the surgical treatment of ankle fractures. For this reason, an intraoperative syndesmosis-test-tool (STT) was developed and compared to the recommended and established hook-test (HT). Tests were performed on cadaveric lower legs (n = 20) and the diastasis was visualized by 3D camera. Tests were performed at 50, 80, and 100 N in native conditions and four instability levels. Instability was induced from anterior to posterior and the reverse on the opposite side. The impact on diastasis regarding the direction, the force level, the instability level, and the device used was checked using a general linear model for repeated measurement. The direction of the induced instability showed no influence on the diastasis during the stability tests. The diastasis measured with the STT increased from 0.5 to 3.0 mm depending on the instability, while the range was lower with the HT (1.1 to 2.3 mm). The results showed that the differentiation between the instability levels was statistically significantly better for the developed STT. The last level of maximum instability was significantly better differentiable with the STT compared to the HT. An average visualizable diastasis of more than 2 mm could only be achieved at maximum instability. In conclusion, the newly developed STT was superior to the commonly used HT to detect instability.
Collapse
Affiliation(s)
- Felix Christian Kohler
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany.
| | - Jakob Hallbauer
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Lea Herrmann
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Bernhard Wilhelm Ullrich
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
| | - Uta Biedermann
- Institute of Anatomy I, Jena University Hospital, Friedrich Schiller University Jena, 07743, Jena, Germany
| | - Britt Wildemann
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Gunther Olaf Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Roland Ramm
- Fraunhofer Institute for Applied Optics and Precision Engineering (IOF), Albert-Einstein-Str. 7, 07745, Jena, Germany
| | - Mark Lenz
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Ivan Marintschev
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
| |
Collapse
|
3
|
Puddu L, Cortese F, Fantinato E, Pescia S, Fiori E, Pisanu F, Doria C, Santandrea A, Lugani G, Mercurio D, Caggiari G. Maisonneuve fracture treated with suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA): Clinical and radiological evaluation in short-medium period. J Orthop 2023; 46:12-17. [PMID: 37954526 PMCID: PMC10632099 DOI: 10.1016/j.jor.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023] Open
Abstract
The aim of this study was to estimate the time needed for patients with Maisonneuve fractures to return to routine activities, after treatment with a suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA). Methods The study included 13 patients treated at our surgical department from January 2018 to June2022. Specific radiographical follow-up and periodic checks were performed in a short -to-medium term period, to evaluate syndesmosis evolution and tibiofibular overlap with medial clear space (MCS). Results Progressive recovery and improvement were observed during follow-up from both radiographic and clinical perspective. Data showed that patients were able to return to full weight-bearing walking around the ninth week and to sport activities in 7.5 months. Long-term complications associated with residual joint stiffness, complex regional pain syndrome, or wound complications were observed in three patients. Conclusions Intraoperative arthroscopy represent a valid diagnostic tool to better recognize and evaluate osteochondral lesions in case of syndesmosys. The study demonstrates the importance of intraoperative arthroscopy for recognizing and treating associated osteochondral lesions with proper syndesmosis evaluation. Plate associated to double TightRope represent valid solution to functionally fix and reduce fractures. Additionally, it imitates the normal syndesmosis's anatomy and provides elasticity and robustness, guaranteeing a rapid return to sporting activity. Data and casuistry support these findings.
Collapse
Affiliation(s)
- L. Puddu
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - F. Cortese
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - E. Fantinato
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - S. Pescia
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - E. Fiori
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - F. Pisanu
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - C. Doria
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - A. Santandrea
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - G. Lugani
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - D. Mercurio
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - G. Caggiari
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| |
Collapse
|