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Ankle fractures
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Oliver Chan, Anthony Sakellariou
Syndesmotic screws should be placed following (preferably open) syndesmotic reduction. A large malleolar (or pelvic) clamp can be used with the tines of the clamp placed on the lateral fibula apex across to the anterior half of the medial malleolus (from posterolateral fibula to anteromedial supra-malleolar area) (Figure 15.11). Evidence suggests that posterior positioning of the medial tine is associated with a greater rate of mal-reduction (34).
Distal tibial fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Paul S. Whiting, William T. Obremskey
Soft tissue considerations such as open wounds, previous scars, extensive swelling or fractures blisters often preclude one or more anatomic approaches to the distal tibia. In such settings, the surgeon must be familiar with multiple surgical approaches and options for fixation. Sheerin et al. reported a technique for fixation of distal tibia fractures with significant anteromedial soft tissue compromise.26 Using a 90-degree cannulated blade plate applied through a posterolateral approach, the authors achieved primary union in 14 of 15 cases; in one case of delayed union, the fracture healed after compression plating with bone grafting. Another useful technique for fixation of distal tibia and fibula fractures in the setting of severe anteromedial soft tissue injury is trans-syndesmotic fixation through the fibula, as described by Sciadini et al.27 In this technique, a 3.5 mm locking compression plate is placed on the posterolateral surface of the fibula after fracture reduction has been performed. Fixation is then extended into the tibia by means of long trans-syndesmotic screws placed through the plate and the fibula (Figure 41.3). Having already passed through two fibular cortices, these screws function as angular stable screws, and together the fibula and plate act as a bridge plate construct for the distal tibia fracture. The authors reported good results with this technique in six patients with minimum follow-up of 14 months (Figure 41.3).
Tibial hemimelia
Published in Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode, Paediatric Orthopaedics, 2016
Treatment involves correction of the foot deformity with soft tissue releases in the early stages and then later correction of the bone deficiency within the tarsus. The ankle will require stabilisation with a syndesmosis screw and, if needed, a tibial osteotomy. The ankle may be stabilised by talofibular fusion if this fails.
Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years
Published in Acta Orthopaedica, 2020
Benedikte Wendt Ræder, Ingrid Kvello Stake, Jan Erik Madsen, Frede Frihagen, Silje Berild Jacobsen, Mette Renate Andersen, Wender Figved
Trauma is the most common cause of ankle OA (Saltzman et al. 2005). The rate of radiologic OA after 2 years was high in this study. The reason for this could be the use of CT, which is more sensitive than radiographs when assessing OA. Most of the patients (48 of 57) displayed only minor signs of OA. The rate of advanced OA in 9 patients is in line with previous studies (Lübbeke et al. 2012, Ray et al. 2019). The observation period of 2 years is short and the study population is underpowered to conclude on the differences in advanced OA between the groups. More patients had complete synostosis in the TS group, supporting the findings by Hinds et al. (2014) that SS fixation is a risk factor for synostosis development. 2 patients treated with SB suffered a non-traumatic fracture through the suture button canal. This specific complication and its incidence have not been reported in the literature. We suggest a syndesmotic screw as a better alternative in patients with poor bone quality.
Reduced incidence and economic cost of hardware removal after ankle fracture surgery: a 20-year nationwide registry study
Published in Acta Orthopaedica, 2020
Nikke Partio, Tuomas T Huttunen, Heikki M Mäenpää, Ville M Mattila
Approximately 10% of all ankle fractures have concomitant syndesmotic injury. In 15–23% of operatively treated ankle fractures, a syndesmotic disruption necessitates surgical repair with a syndesmotic screw (Jensen et al. 1998, Egol et al. 2010). However, the need to remove this screw remains controversial. In his literature review in 2011 (including 7 studies between 2000 and 2010), Schepers (2011) reported that there is no need to routinely remove the syndesmotic screws. In a recent systematic review, Dingemans et al. (2016) also suggest that the current literature does not support the routine removal of syndesmotic screws. Furthermore, the complication rate for routine syndesmotic screw removal is about 20% (Schepers et al. 2011). Fenelon et al. (2019) showed in their study that 6% of all patients underwent planned hardware removal and that the majority of procedures were for the removal of a syndesmosis screw after a median time of 3 months. Our register study could not separate all hardware removals from only syndesmotic screw removal, but we assume that most removals within 3 months were of syndesmotic screws. This assumption is supported by the fact that these procedures decreased markedly between 2011 and 2016, most likely due to the changed evidence suggesting syndesmotic screws need not be removed (Figure) (Schepers 2011).
Computational biomechanical analysis of postoperative inferior tibiofibular syndesmosis: a modified modeling method
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Haobo Li, Yanxi Chen, Minfei Qiang, Kun Zhang, Yuchen Jiang, Yijie Zhang, Xiaoyang Jia
Currently, different kinds of treatment for inferior tibiofibular syndesmosis injury have been used, while the syndesmotic screw fixation is the most applied method (Manjoo et al. 2010). As a common complication of ankle fracture (5–10%) (Egol et al. 2010), inferior tibiofibular syndesmosis injury with improper treatment can lead to instability of the ankle, which may cause chronic pain, traumatic arthritis, and other complications (Wang et al. 2015). Nevertheless, various methods of screw fixation such as those involving different numbers, materials, diameters, and positions of the screw and different number of cortices the screw gets through are still under-discussed and different research conclusions have been reported (Hoiness and Stromsoe 2004; Manjoo, Sanders, Tieszer and MacLeod 2010).