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The utilization of intraoperative contralateral ankle images for syndesmotic reduction

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the variability in ankle syndesmotic morphology on contralateral ankle fluoroscopic images and the reductions obtained utilizing these images.

Methods

A retrospective cohort study was performed at a level one trauma center including 46 adult patients undergoing operative fixation of malleolar ankle fractures that also had anteroposterior (AP) and lateral fluoroscopic images of the uninjured contralateral ankle intraoperatively. Contralateral and post-fixation fluoroscopic images were used to measure the tibiofibular clear space (TFCS) as a proportion of the superior clear space (SCS) on mortise images and the posterior tibiofibular distance (PTFD) as a proportion of the lateral superior clear space (LSCS) on lateral images. Differences between contralateral and post-fixation ankle measurements were compared between those patients with syndesmotic injuries and those without (control group).

Results

The mean TFCS/SCS and PTFD/LSCS ratios measured on contralateral ankle images were 1.2 (95% confidence interval (CI) 1.1 to 1.3; range 0.7 to 1.8) and 1.8 (95% CI 1.5 to 2; range 0.5 to 3.4). The mean difference between the contralateral and post-fixation TFCS/SCS and PTFD/LSCS in patients with and without syndesmotic fixation was 0.07 vs. 0.13 (F-ratio 0.3, p = 0.5) and −0.2 vs 0.5 (F ratio 5.2,  p= 0.02).

Conclusions

Contralateral syndesmotic measurements varied widely and the utilization of these images allowed for syndesmotic reductions with similar measurements. Intraoperative contralateral ankle images should be considered to assess syndesmotic reduction.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China

    Xiangquan Chu

  2. Department of Orthopaedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

    Motasem Salameh

  3. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea

    Seong-Eun Byun

  4. Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC, 0188, 80204, Denver, CO, US

    Michael Hadeed, Steven Stacey, Cyril Mauffrey & Joshua A. Parry

Authors
  1. Xiangquan Chu
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  2. Motasem Salameh
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  3. Seong-Eun Byun
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  4. Michael Hadeed
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  5. Steven Stacey
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  6. Cyril Mauffrey
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  7. Joshua A. Parry
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Correspondence to Joshua A. Parry.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The institutional review board approved this study. Due to the retrospective nature of this work, informed consent was waived.

Declarations of Interest

None of the authors have financial conflicts of interest relevant to the content of this study.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Chu, X., Salameh, M., Byun, SE. et al. The utilization of intraoperative contralateral ankle images for syndesmotic reduction. Eur J Orthop Surg Traumatol 32, 347–351 (2022). https://doi.org/10.1007/s00590-021-02984-4

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  • DOI: https://doi.org/10.1007/s00590-021-02984-4

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