Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ahl T, Dalén N, Lundberg A, Selvik G (1987) Mobility of the ankle mortise. A roentgen stereophotogrammetric analysis. Acta Orthop Scand 58:401–402

    PubMed  CAS  Google Scholar 

  2. Ahl T, Dalen N, Selvik G (1989) Ankle fractures. A clinical and roentgenographic stereophotogrammetric study. Clin Orthop 246–255

  3. Ahl T, Dalén N, Lundberg A, Wykman A (1994) Biodegradable fixation of ankle fractures. A roentgen stereophotogrammetric study of 32 cases. Acta Orthop Scand 65:166–170

    PubMed  CAS  Google Scholar 

  4. Amendola A (1992) Controversies in diagnosis and management of syndesmosis injuries of the ankle. Foot Ankle 13:44–50

    PubMed  CAS  Google Scholar 

  5. Barnett CH, Napier JR (1952) The axis of rotation at the ankle joint in man. Its influence upon the form of the talus and the mobility of the fibula. J Anat 86:1–9

    PubMed  CAS  Google Scholar 

  6. Boden SD, Labropoulos PA, McCowin P, Lestini WF, Hurwitz SR (1989) Mechanical considerations for the syndesmosis screw. A cadaver study. J Bone Joint Surg Am 71:1548–1555

    PubMed  CAS  Google Scholar 

  7. Burwell HN, Charnley AD (1965) The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br 47:634–660

    PubMed  CAS  Google Scholar 

  8. Cappozzo A, Cappello A, Della Croce U, Pensalfini F (1997) Surface-marker cluster design criteria for 3-D bone movement reconstruction. IEEE Trans Biomed Eng 44:1165–1174

    Article  PubMed  CAS  Google Scholar 

  9. Close JR (1956) Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am 38:761–781

    PubMed  Google Scholar 

  10. Colton CL (1968) Fracture-diastasis of the inferior tibio-fibular joint. J Bone Joint Surg Br 50:830–835

    PubMed  CAS  Google Scholar 

  11. Colton CL (1971) The treatment of Dupuytren’s fracture-dislocation of the ankle. J Bone Joint Surg Br 53:63–71

    PubMed  CAS  Google Scholar 

  12. Edwards GS Jr, DeLee JC (1984) Ankle diastasis without fracture. Foot Ankle 4:305–312

    PubMed  Google Scholar 

  13. Farhan MJ, Smith TW (1985) Fixation of diastasis of the inferior tibiofibular joint using the syndesmosis hook. Injury 16:309–311

    Article  PubMed  CAS  Google Scholar 

  14. Grath GB (1960) Widening of the ankle mortise. A clinical and experimental study. Acta Chir Scand 41(Suppl):263

    Google Scholar 

  15. Guise ER (1976) Rotational ligamentous injuries to the ankle in football. Am J Sports Med 4:1–6

    Article  PubMed  CAS  Google Scholar 

  16. Inman VT (1976) The joints of the ankle. Williams & Wilkins, Baltimore, MD

    Google Scholar 

  17. Karrholm J (1989) Roentgen stereophotogrammetry. Review of orthopedic applications. Acta Orthop Scand 60:491–503

    PubMed  CAS  Google Scholar 

  18. Kaye RA (1989) Stabilization of ankle syndesmosis injuries with a syndesmosis screw. Foot Ankle 9:290–293

    PubMed  CAS  Google Scholar 

  19. Leeds HC, Ehrlich MG (1984) Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am 66:490–503

    PubMed  CAS  Google Scholar 

  20. Lofvenberg R, Karrholm J, Selvik G, Hansson LI, Ahlgren O (1989) Chronic lateral instability of the ankle. Roentgen stereophotogrammetry of talar position. Acta Orthop Scand 60:34–39

    Article  PubMed  CAS  Google Scholar 

  21. Lofvenberg R, Karrholm J, Selvik G (1990) Fibular mobility in chronic lateral instability of the ankle. Foot Ankle 11:22–29

    PubMed  CAS  Google Scholar 

  22. Lofvenberg R, Karrholm J, Ahlgren O (1994) Ligament reconstruction for ankle instability. A 5-year prospective RSA follow-up of 30 cases. Acta Orthop Scand 65:401–407

    PubMed  CAS  Google Scholar 

  23. Marymont JV, Lynch MA, Henning CE (1986) Acute ligamentous diastasis of the ankle without fracture. Evaluation by radionuclide imaging. Am J Sports Med 14:407–409

    Article  PubMed  CAS  Google Scholar 

  24. Mast JW, Teipner WA (1980) A reproducible approach to the internal fixation of adult ankle fractures: rationale, technique, and early results. Orthop Clin North Am 11:661–679

    PubMed  CAS  Google Scholar 

  25. Miller CD, Shelton WR, Barrett GR, Savoie FH, Dukes AD (1995) Deltoid and syndesmosis ligament injury of the ankle without fracture. Am J Sports Med 23:746–750

    Article  PubMed  CAS  Google Scholar 

  26. Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of internal fixation—techniques recommended by the AO-ASIF Group. Springer, Berlin Heidelberg New York

    Google Scholar 

  27. Olerud S (1971) Subluxation of the ankle without fracture of the fibula. A case report. J Bone Joint Surg Am 53:594–596

    PubMed  CAS  Google Scholar 

  28. Olerud C (1985) The effect of the syndesmotic screw on the extension capacity of the ankle joint. Arch Orthop Trauma Surg 104:299–302

    Article  PubMed  CAS  Google Scholar 

  29. Pankovich AM (1976) Maisonneuve fracture of the fibula. J Bone Joint Surg Am 58:337–342

    PubMed  CAS  Google Scholar 

  30. Peter RE, Harrington RM, Henley MB, Tencer AF (1994) Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques. J Orthop Trauma 8:215–219

    Article  PubMed  CAS  Google Scholar 

  31. Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, Laros GS (1985) A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am 67:67–78

    PubMed  CAS  Google Scholar 

  32. Riegels-Nielsen P, Christensen J, Greiff J (1983) The stability of the tibio-fibular syndesmosis following rigid internal fixation for type C malleolar fractures: an experimental and clinical study. Injury 14:357–360

    Article  PubMed  CAS  Google Scholar 

  33. Ryd L (1986) Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation. Acta Orthop Scand Suppl 220:1–80

    PubMed  CAS  Google Scholar 

  34. Ryd L, Yuan X, Lofgren H (2000) Methods for determining the accuracy of radiostereometric analysis (RSA). Acta Orthop Scand 71:403–408

    Article  PubMed  CAS  Google Scholar 

  35. Sclafani SJ (1985) Ligamentous injury of the lower tibiofibular syndesmosis: radiographic evidence. Radiology 156:21–27

    PubMed  CAS  Google Scholar 

  36. Selvik G (1989) Roentgen stereophotogrammetry. A method for the study of the kinematics of the skeletal system. Acta Orthop Scand Suppl 232:1–51

    PubMed  CAS  Google Scholar 

  37. Selvik G (1990) Roentgen stereophotogrammetric analysis. Acta Radiol 31:113–126

    Article  PubMed  CAS  Google Scholar 

  38. Selvik G, Alberius P, Aronson AS (1983) A roentgen stereophotogrammetric system. Construction, calibration and technical accuracy. Acta Radiol Diagn (Stockh) 24:343–352

    CAS  Google Scholar 

  39. Slawski DP, West C (1995) Maisonneuve fracture with an associated distal fibular fracture. A case report. Clin Orthop 193–198

  40. Soavi R, Girolami M, Loreti I, Bragonzoni L, Monti C, Visani A, Marcacci M (2000) The mobility of the proximal tibio-fibular joint. A Roentgen stereophotogrammetric analysis on six cadaver specimens. Foot Ankle Int 21:336–342

    PubMed  CAS  Google Scholar 

  41. Söderkvist I, Wedin PA (1993) Determining the movements of the skeleton using well-configured markers. J Biomech 26(12):1473–1477

    Article  PubMed  Google Scholar 

  42. Solari J, Benjamin J, Wilson J, Lee R, Pitt M (1991) Ankle mortise stability in Weber C fractures: indications for syndesmotic fixation. J Orthop Trauma 5:190–195

    Article  PubMed  CAS  Google Scholar 

  43. de Souza LJ, Gustilo RB, Meyer TJ (1985) Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg Am 67:1066–1074

    PubMed  Google Scholar 

  44. Tornetta P, Spoo JE, Reynolds FA, Lee C (2001) Overtightening of the ankle syndesmosis: is it really possible? J Bone Joint Surg Am 83:489–492

    PubMed  Google Scholar 

  45. Wuest TK (1997) Injuries to the distal lower extremity syndesmosis. J Am Acad Orthop Surg 5:172–181

    PubMed  Google Scholar 

  46. Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA (1995) The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am 77:847–856

    PubMed  CAS  Google Scholar 

  47. Yamaguchi K, Martin CH, Boden SD, Labropoulos PA (1994) Operative treatment of syndesmotic disruptions without use of a syndesmotic screw: a prospective clinical study. Foot Ankle Int 15:407–414

    PubMed  CAS  Google Scholar 

  48. Yuan X, Ryd L (2000) Accuracy analysis for RSA: a computer simulation study on 3D marker reconstruction. J Biomech 33:493–498

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Vito Amabile, Luciano Ussia and Valentina Matti of the Radiology Department for their essential cooperation, Elettra Pignotti for her help with statistical data processing, Carmelo Carcasio for the technical support, and Silvia Bassini for her assistance with graphics.

Author information

Authors and Affiliations

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

    Laura Bragonzoni, Alessandro Russo, Andrea Visani, Nicoletta Mazzotti & Maurilio Marcacci

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

    Mauro Girolami

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

    Ugo Albisinni

Authors
  1. Laura Bragonzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mauro Girolami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ugo Albisinni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Visani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicoletta Mazzotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maurilio Marcacci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura Bragonzoni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bragonzoni, L., Russo, A., Girolami, M. et al. The distal tibiofibular syndesmosis during passive foot flexion. RSA-based study on intact, ligament injured and screw fixed cadaver specimens. Arch Orthop Trauma Surg 126, 304–308 (2006). https://doi.org/10.1007/s00402-006-0131-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-006-0131-8

Keywords

Search

Navigation