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-
1
Bartoníček J, Rammelt S, Kostlivý K, et al: Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg 135: 505, 2015.
-
2
Gardner MJ, Brodsky A, Briggs SM, et al: Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res 447: 165, 2006.
-
3
Bartoníček J, Rammelt S, Tuček M, et al: Posterior malleolar fractures of the ankle. Eur J Trauma Emerg Surg 41: 587, 2015.
-
4
Miller AN, Carroll EA, Parker RJ, et al: Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res 468: 1129, 2010.
-
5
Clanton TO, Williams BT, Backus JD, et al: Biomechanical analysis of the ındividual ligament contributions to syndesmotic stability. Foot Ankle Int 38: 66, 2017.
-
6
Mason LW, Marlow WJ, Widnall J, et al: Pathoanatomy and associated ınjuries of posterior malleolus fracture of the ankle. Foot Ankle Int 38: 1229, 2017.
-
7
Gardner MJ, Demetrakopoulos D, Briggs SM, et al: Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int 27: 788, 2006.
-
8
Hovis WD, Kaiser BW, Watson JT, et al: Treatment of syndesmotic disruptions of the ankle with bioabsorbable screw fixation. J Bone Joint Surg Am 84: 26, 2002.
-
9
Weening B, Bhandari M: Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma 19: 102, 2005.
-
10
Miller AN, Carroll EA, Parker RJ, et al: Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int 30: 419, 2009.
-
11
Warner SJ, Garner MR, Hinds RM, et al: Correlation between the Lauge-Hansen classification and ligament ınjuries in ankle fractures. J OrthopTrauma 29: 574, 2015.
-
12
Holzer N, Salvo D, Marijnissen ACA, et al: Radiographic evaluation of posttraumatic osteoarthritis of the ankle: the Kellgren-Lawrence scale is reliable and correlates with clinical symptoms. Osteoarthritis Cartilage 23: 363, 2015.
-
13
Miller AN, Barei DP, Iaquinto JM, et al: Iatrogenic syndesmosis malreduction via clamp and screw placement. J Orthop Trauma 27: 100, 2013.
-
14
Kennedy MT, Carmody O, Leong S, et al: A computed tomography evaluation of two hundred normal ankles, to ascertain what anatomical landmarks to use when compressing or placing an ankle syndesmosis screw. Foot (Edinb) 24: 157, 2014.
-
15
Tornetta P III, Spoo JE, Reynolds FA, et al: Overtightening of the ankle syndesmosis: is it really possible? J Bone Joint Surg Am 83: 489, 2001.
-
16
Bartoníček J, Rammelt S, Tuček M: Posterior malleolar fractures: changing concepts and recent developments. Foot Ankle Clin 22: 125, 2017.
-
17
Jayatilaka MLT, Philpott MDG, Fisher A, et al: Anatomy of the insertion of the posterior inferior tibiofibular ligament and the posterior malleolar fracture. Foot Ankle Int 40: 1319, 2019.
-
18
Marmor M, Hansen E, Han HK, et al: Limitations of standard fluoroscopy in detecting rotational malreduction of the syndesmosis in an ankle fracture model. Foot Ankle Int 32: 616, 20111.
-
19
Bali N, Aktselis I, Ramasamy A, et al: An evolution in the management of fractures of the ankle: safety and efficacy of posteromedial approach for Haraguchi type 2 posterior malleolar fractures. Bone Joint J 99-B: 1496, 2017.
-
20
Bauer AS, Bluman EM, Wilson MG, et al: Injuries of the distal lower extremity syndesmosis. Curr Orthop Pract 20: 111, 2009.
-
21
Moore JA Jr, Shank JR, Morgan SJ, et al: Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal. Foot Ankle Int 27: 567, 2006.
-
22
Manjoo A, Sanders DW, Tieszer C, et al: Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal. J Orthop Trauma 24: 2, 2010.
-
23
Song DJ, Lanzi JT, Groth AT, et al: The effect of syndesmosis screw removal on the reduction of the distal tibiofibular joint: a prospective radiographic study. Foot Ankle Int 35: 543, 2014.
-
24
Weening B, Bhandari M: Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma 19: 102, 2005.
-
25
Warner SJ, Fabricant PD, Garner MR, et al: The measurement and clinical importance of syndesmotic reduction after operative fixation of rotational ankle fractures. J Bone Joint Surg Am 97: 1935, 2015.
-
26
Rasi AM, Kazemian G, Omidian MM, et al: Syndesmotic malreduction after ankle ORIF; is radiography sufficient? Arch Bone Joint Surg 1: 98, 2013.
Syndesmosis Injuries in Lateral Malleolar Fractures Accompanied by a Posterior Malleolar Fracture: A Nonfixed Posterior Fracture Fragment May Not Affect Postoperative Tibiofibular Joint Malreduction Rates
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Background: The fact that lateral malleolar fracture is accompanied by posterior malleolar fracture may adversely affect syndesmosis malreduction rates. We aimed to compare syndesmosis malreduction rates determined on postoperative radiographs between isolated lateral malleolar fractures and lateral malleolar fractures accompanied by posterior malleolar fractures.
Methods: We retrospectively examined 128 operative patients: 73 with isolated lateral malleolar fractures (group L) and 55 with lateral + posterior malleolar fractures (group LP). In group LP, no patients received posterior fragment fixation. In both groups, indirect syndesmosis fixation was performed with a single screw after open reduction and internal fixation of the lateral malleolus. Patient age, sex, fracture side, fracture type (Lauge-Hansen and Danis-Weber classifications), Kellgren-Lawrence osteoarthritis classification, syndesmotic incongruency on postoperative radiographs, syndesmotic malreduction of postoperative fibula fracture, fracture union time, complication rates, accompanying injuries, and preoperative and postoperative radiographic syndesmotic measurements (tibiofibular overlap, tibiofibular clear space, medial clear space) were recorded, and the groups were compared.
Results: Mean ± SD age was 44.32 ± 15.66 years in group L and 48.93 ± 14.03 years in group LP (P = .087). There were no significant differences in preoperative and postoperative tibiofibular distance, tibiofibular overlap, and medial clear space values between groups (P > .05). The prevalence of grade 2 fractures according to the Kellgren-Lawrence classification was significantly higher in group LP (P = .047). Postoperative syndesmosis malreduction was detected in 12 patients in group L and in nine in group LP (P = .991).
Conclusions: In lateral malleolar fractures accompanied by small-fragment posterolateral or avulsion-type posterior malleolar fractures, closed syndesmotic screw fixation does not cause syndesmosis malreduction.
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