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1
Sharif, Ban, Matthew Welck, and Asif Saifuddin. "MRI of the distal tibiofibular joint." Skeletal Radiology 49, no. 1 (July 9, 2019): 1–17. http://dx.doi.org/10.1007/s00256-019-03260-7.
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Castro, Allex Amaral, José Vicente Pansini, Elicimar Beltran Martins, Adham Amaral Castro, and Eduardo Kaiser Ururahy Nunes. "Tomographic control of sindesmosis reduction after surgical fixation." Scientific Journal of the Foot & Ankle 12, no. 4 (December 30, 2018): 298–303. http://dx.doi.org/10.30795/scijfootankle.2018.v12.829.
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Objective: To determine percentages of types A (flat) and B (concave) of the distal tibiofibular joint in patients with ankle fractures or chronic ligament instabilities, with syndesmosis lesions; check the shape of the fixation and position of the fibula in this joint; to identify poor fibular reduction and its frequency in types A and B; patients according to the AOFAS criteria. Methods: 104 patients surgically treated with syndesmosis fixation underwent clinical evaluation using AOFAS functional criteria and tomographic exams to classify the distal tibiofibular joint in types A or B and evaluated the poor position of the fibula in this joint. Results: Distal tibiofibular joint type A was present in 27 ankles and type B in 77. Non-anatomical reduction of the fibula (17 ankles) was more frequent in type A than in type B and more frequent in fractures than in instabilities. The AOFAS score was 91.79 points in the 87 patients with good reduction and 86.76 points in the 17 patients with poor fibula reduction. Conclusion: Distal tibiofibular joint type B was more frequent than type A (p=0.00001); there was poor reduction of the fibula in this joint in 17 ankles (16.34%). Poor fibula reduction was more frequent in fractures than in instabilities (p=0.006). The poor reduction was more constant in type A than in type B, without statistical significance (p=0.34). The AOFAS score was 91.79 points in patients with good reduction and 86.76 points in patients with poor fibula reduction in the distal tibiofibular joint. Level of Evidence IV; Therapeutic Studies; Case Series.
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H�cker, K. "The skeletal radiology of the distal tibiofibular joint." Archives of Orthopaedic and Trauma Surgery 113, no. 6 (October 1994): 345–46. http://dx.doi.org/10.1007/bf00426185.
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Teramoto, Atsushi, Hideji Kura, Eiichi Uchiyama, Daisuke Suzuki, and Toshihiko Yamashita. "Three-Dimensional Analysis of Ankle Instability after Tibiofibular Syndesmosis Injuries." American Journal of Sports Medicine 36, no. 2 (October 16, 2007): 348–52. http://dx.doi.org/10.1177/0363546507308235.
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Background Rupture of the distal tibiofibular syndesmosis commonly occurs with extreme external rotation. Most studies of syndesmosis injuries have concentrated only on external rotation instability of the ankle joint and have not examined other defects. Hypothesis Syndesmosis injuries cause multidirectional ankle instability. Study Design Controlled laboratory study. Methods Ankle instability caused by distal tibiofibular syndesmosis injuries was examined using 7 normal fresh-frozen cadaveric legs. The anterior tibiofibular ligament, interosseous membrane, and posterior tibiofibular ligament, which compose the distal tibiofibular syndesmosis, were sequentially cut. Anterior, posterior, medial, and lateral traction forces, as well as internal and external rotation torque, were applied to the tibia; the diastasis between the tibia and fibula and the angular motion among the tibia, fibula, and talus were measured using a magnetic tracking system. Results A medial traction force with a cut anterior tibiofibular ligament significantly increased the diastasis from 1.1 to 2.0 mm ( P = .001) and talar tilt angles from 9.6° to 15.2° ( P < .001). External rotation torque significantly increased the diastasis from 0.5 to 1.8 mm ( P= .009) with a complete cut; external rotation torque also significantly increased rotational angles from 7.1° to 9.4° ( P = .05) with an anterior tibiofibular ligament cut. Conclusion Syndesmosis injuries caused ankle instability with medial traction force and external rotation torque to the tibia. Clinical Relevance Both physicians and athletes should be aware of inversion instability of the ankle joint caused by tibiofibular syndesmosis injuries.
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Yablon, Isadore G. "Occult Malunion of Ankle Fractures—A Cause of Disability in the Athlete." Foot & Ankle 7, no. 5 (April 1987): 300–304. http://dx.doi.org/10.1177/107110078700700506.
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Occult malunion of the ankle is a condition in which the talus appears to be situated in its normal position on standard radiographs. The lateral malleolus, however, is incompletely reduced. This causes a subluxation of the distal tibiofibular joint and some degree of talar instability. The malunion of the lateral malleolus is best visualized on lateral radiographs or tomograms. This condition can be corrected by osteotomizing the lateral malleolus and restoring the integrity of the distal tibiofibular joint by pulling the lateral malleolus distally and internally rotating it.
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Yang, Huarui, Kangquan Shou, Shijun Wei, Zhi Fang, Qiwen Hu, Qiong Wan, Yi Yang, and Tongzhu Bao. "A Revised Surgical Strategy for the Distal Tibiofibular Interosseous Osteochondroma." BioMed Research International 2020 (May 8, 2020): 1–7. http://dx.doi.org/10.1155/2020/6371456.
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Osteochondroma is one of the most common benign bone tumor; however, the surgical treatment still remains a challenge for those that occur at the distal tibiofibular interosseous location. Previously, the transfibular approach has been successfully described, but the potential damage of the syndesmosis would give rise to the instability of the ankle joint and thus may result in the unfavorable long-term outcome. Here, a revised strategy which can protect the syndesmotic complex is introduced. From 2010 to 2017, eleven patients with the distal tibiofibular interosseous osteochondroma who underwent the revised surgery were collected. The distal fibular osteotomy and posterior tibial osteotomy were performed to keep the inferior syndesmosis intact for better stability of the ankle joint. Both the anterior tibiofibular ligaments (AITFL) and posterior tibiofibular ligaments (PITFL) have been preserved successfully, and thus, the stability of the ankle joint has been maintained due to our strategy. The VAS and AOFAS scores were utilized to assess the clinical outcome and function. Postoperatively, all the patients were pain-free and were able to wear the appropriate shoes at the last follow-up. Preoperative and postoperative AOFAS scores were 93.63±6.91 and 47.27±5.27 (P<0.05), respectively. Moreover, the average VAS score was 1.73±0.27 (compared with preoperative as 7.45±2.15, P<0.05), demonstrating obvious improvement after the operation. To our best knowledge, this is the first time to perform the resection of the distal tibial interosseous osteochondroma involving the fibula without interrupting the inferior syndesmotic complex especially the AITFL and PITFL. We believe that this strategy may pave a new way for optimized clinical outcome for these patients with distal tibiofibular interosseous osteochondroma. This clinical trial study is registered with number ChiCTR1900024690.
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Brandao, Roberto A., and Dane K. Wukich. "A Curious Distal Tibiofibular Neuropathic Fracture." Foot & Ankle Specialist 9, no. 6 (June 23, 2016): 563–66. http://dx.doi.org/10.1177/1938640016640893.
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Hindfoot and distal leg neuropathic fracture collapse secondary to normal pressure hydrocephalus is a very rare clinical pathology. The authors present a case of a 69-year-old woman who sustained a distal tibiofibular fracture that resulted in a recurvatum deformity with idiopathic neuropathy and gait instability on initial presentation. A subtalar and ankle joint arthrodesis was performed achieving rectus alignment of the lower extremity with no postoperative complications. Her neuropathic etiology was negative for common causative factors, including diabetes, infection, nutritional deficiencies, congenital neuropathy, and trauma. Approximately 6 months postoperatively, the patient had persistent bilateral lower extremity weakness with the sensation of her “feet sticking to the floor” on ambulation. A referral to neurology revealed a normal pressure hydrocephalus as a possible etiology for her gait abnormalities and neuropathy. She required a ventriculoperitoneal shunt, with resolved gait disturbance and associated weakness approximately 1.5 years postoperatively. Levels of Evidence: Therapeutic, Level IV: Case report
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Gräff, Pascal, Sulaiman Alanazi, Sulaiman Alazzawi, Sanjay Weber-Spickschen, Christian Krettek, Antonios Dratzidis, Benjamin Fleischer-Lueck, Nael Hawi, and Emmanouil Liodakis. "Screw fixation for syndesmotic injury is stronger and provides more contact area of the joint surface than TightRope®: A biomechanical study." Technology and Health Care 28, no. 5 (September 18, 2020): 533–39. http://dx.doi.org/10.3233/thc-191638.
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BACKGROUND: The rupture of syndesmotic ligaments is treated with a screw fixation as the gold standard. An alternative is the stabilization with a TightRope®. A couple of studies investigated the different clinical outcome and some even looked at the stability in the joint, but none of them examined the occurring pressure after fixation. OBJECTIVE: Is there a difference in pressure inside the distal tibiofibular joint between a screw fixation and a TightRope®? Does the contact area differ in these two treatment options? METHODS: This biomechanical study aimed to investigate the differences in fixation of the injured syndesmotic ligaments by using a fixation with one quadricortical screw versus singular TightRope® both implanted 1 cm above the joint. By using 12 adult lower leg cadaveric specimens and pressure recording sensor, we recorded the pressure across the distal tibiofibular joint. Additionally we measured the contact surface area across the joint. RESULTS: The mean of the pressure across the distal tibiofibular joint from the start of the insertion of the fixation device to the complete fixation was 0.05 Pascal for the TightRope® and 0.1 for the screw (P= 0.016). The mean of the maximum pressure across the joint (after completion of fixation and releasing the reduction clamp) was 1.750 mega Pascal with the screw fixation and 0.540 mega Pascal with TightRope® (P= 0.008). The mean of the measured contact area of the distal tibiofibular joint after fixation was 250 mm2 in the TightRope® group and of 355 mm2 in the screw fixation (P= 0.123). CONCLUSIONS: The screw fixation is stronger and provides a larger surface contact area, which leads us to the conclusion that it provides a better stability in the joint. While previous clinical studies did not show significant clinical difference between the two methods of fixation, the biomechanical construct varied. Long term clinical studies are required to establish whether this biomechanical distinction will contribute to various clinical outcomes.
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Pesl, T., and P. Havranek. "Rare Injuries to the Distal Tibiofibular Joint in Children." European Journal of Pediatric Surgery 16, no. 4 (August 2006): 255–59. http://dx.doi.org/10.1055/s-2006-924457.
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Zarate, Stephanie D., David M. Joyce, and Ana C. Belzarena. "Tenosynovial giant cell tumor of the distal tibiofibular joint." Radiology Case Reports 16, no. 4 (April 2021): 950–55. http://dx.doi.org/10.1016/j.radcr.2021.01.064.
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Yuen, Chi Pan, and Tun Hing Lui. "Distal Tibiofibular Syndesmosis: Anatomy, Biomechanics, Injury and Management." Open Orthopaedics Journal 11, no. 1 (July 31, 2017): 670–77. http://dx.doi.org/10.2174/1874325001711010670.
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A stable and precise articulation of the distal tibiofibular syndesmosis is essential for normal motion of the ankle joint. Injury to the syndesmosis occurs through rupture or bony avulsion of the syndesmotic ligament complex. External rotation of the talus has been identified as the major mechanism of syndesmotic injury. None of the syndesmotic stress tests was sensitive or specific; therefore the diagnosis of syndesmotic injury should not be made based on the medical history and physical examination alone. With the improvement in ankle arthroscopic technique, it can be used as a diagnostic and therapeutic tool in the management of distal tibiofibular syndesmosis injury.
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Barrow, Craig R., and Gregory C. Pomeroy. "Enhancement of Syndesmotic Fusion Rates in Total Ankle Arthroplasty with the Use of Autologous Platelet Concentrate." Foot & Ankle International 26, no. 6 (June 2005): 458–61. http://dx.doi.org/10.1177/107110070502600606.
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Background: One of the challenges of total ankle arthroplasty continues to be achieving a solid distal fusion of the tibiofibular joint. Delayed union rates of 29% to 38% and the nonunion rates of 9% to 18% for syndesmotic fusion have been documented. The risk of tibial component migration has been reported to increase 8.5 times if a solid syndesmotic fusion is absent. Growth factors have been shown to accelerate bone healing and may enhance the fusion of the syndesmosis and, thereby, decrease the frequency of nonunion and subsequent tibial component migration. Methods: An autologous platelet concentrate was used to increase the amount of growth factors at the site of the distal tibiofibular joint fusion in 20 total ankle arthroplasties. Results: Our 6-month fusion rate was 100%. When compared to historical controls (6-month fusion rate of 62%) the difference was statistically significant ( p < 0.0001). Conclusion: The improved rate of distal tibiofibular fusion may be attributable to the increased presence of growth factors provided by an autologous platelet concentrate.
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T, Sreenivas. "Congenital Distal Tibiofibular Synostosis - A Case Report." International Journal of Health Sciences and Research 11, no. 9 (September 14, 2021): 178–80. http://dx.doi.org/10.52403/ijhsr.20210927.
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Congenital tibiofibular synostosis is the fusion of tibia and fibula since birth. So far there are many reports of congenital proximal tibio fibular synostosis in English literature, but congenital distal tibio fibular synostosis is very rarely described. Imaging studies by means of X rays, CT and MRI are required to rule out osteochondromas arising from distal tibia, fibula and other conditions. If the patient is symptomatic by means of deformity surgical intervention in the form of corrective osteotomy may be considered to prevent alternation of joint biomechanics. We report a rare case of congenital distal tibiofibular synostosis in a 21 year old female presented with complaints of deformity and pain on and off in left lower leg since childhood. Key words: Congenital; Synostosis; Deformity; Osteochondroma.
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Fujii, Misaki, Daisuke Suzuki, Eiichi Uchiyama, Takayuki Muraki, Atsushi Teramoto, Mitsuhiro Aoki, and Shigenori Miyamoto. "Does distal tibiofibular joint mobilization decrease limitation of ankle dorsiflexion?" Manual Therapy 15, no. 1 (February 2010): 117–21. http://dx.doi.org/10.1016/j.math.2009.08.008.
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Ribbans, WJ, J. Chadwick, and R. Natarajan. "Bilateral arthrodesis of the distal tibiofibular joint for deforming osteochondromatas." JRSM Open 8, no. 8 (August 2017): 205427041771871. http://dx.doi.org/10.1177/2054270417718712.
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Qin, Di, Wei Chen, Juan Wang, Hongzhi Lv, Wenhui Ma, Tianhua Dong, and Yingze Zhang. "Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study." Journal of International Medical Research 46, no. 8 (May 30, 2018): 3114–23. http://dx.doi.org/10.1177/0300060518772715.
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Objectives This study was performed to explore the mechanism of proximal fibular osteotomy (PFO) for treatment of medial compartment knee osteoarthritis (OA) and evaluate the relevant factors influencing the treatment outcome. Methods Fifty-two patients with medial compartment knee OA with varus deformities were prospectively selected. Radiographs were obtained preoperatively and postoperatively. Knee function and OA severity were evaluated using the Hospital for Special Surgery (HSS) knee score and the Kellgren–Lawrence (KL) score. Multivariable linear regression models were used to examine associations between increases in the HSS score and selected factors influencing knee OA. Results Sixty-seven knee joints of 45 patients undergoing PFO were included. The HSS scores were significantly better at the final follow-up than preoperatively. Regression analysis identified five factors influencing changes in the HSS score: the change in the vertical distance between the fibular head and tibial plateau, the KL score for tibiofibular joint arthritis, the body mass index, the inclination of the tibiofibular joint, and the preoperative HSS score. Conclusions PFO is a simple and effective procedure for medial compartment knee OA. Greater distal displacement of the fibular head suggests greater range of motion of the tibiofibular joint and more evident improvement of postoperative OA symptoms.
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Neumann, Julie, Maxwell Weinberg, Chong Zhang, Charles Saltzman, and Alexej Barg. "Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?" Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0036. http://dx.doi.org/10.1177/2473011418s00367.
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Category: Ankle Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. To date, it is unclear whether concurrent distal tibio-fibular joint arthrodesis affects this nonunion rate as there have been no studies directly comparing patients with and without arthrodesis of the distal tibio-fibular joint. The purpose of this clinical study is to compare the rate of nonunion in patients with a distal tibio-fibular fusion to those without a distal tibio-fibular fusion in the setting of a primary, open ankle arthrodesis. The hypothesis of this study was that the addition of a distal tibio-fibular fusion would decrease the nonunion rate in patients undergoing open ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. 366 ankles from 354 unique patients met inclusion criteria. All patients underwent primary, open tibiotalar arthrodesis. 250 patients underwent open tibiotalar arthrodesis with a distal tibio-fibular fusion and 116 patients underwent open tibiotalar arthrodesis without a distal tibio-fibular fusion. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was nonunion rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, and rate of development of post-operative deep vein thrombosis (DVT)/Pulmonary embolism (PE). Results: Average age of the patients was 56.2 +/- 14.2 years. Mean follow-up time was 33.8 months. Unions were assessed on routine post-operative radiographs and by clinical examination. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had the distal tibio-fibular joint included was 19/250 (8%) and nonunion rate of those who did not have the distal tibio-fibular joint fused was 14/116 (12%) (p=0.16). There was no significant difference between those who had the distal tibio-fibular joint included versus who did not in wound complication rate (27% vs 31%, p=0.40), time to union (4.9 weeks versus 5 weeks, p =0.54), and DVT/PE rate (5% vs 3%, p=0.41), respectively [Table 1]. There were no major complications. Conclusion: To our knowledge, this is the first study directly comparing nonunion rates and complication rates in patients who underwent primary, open ankle arthrodesis with and without distal tibio-fibular joint arthrodesis. In this study, inclusion of the distal tibio-fibular joint in tibiotalar arthrodesis does not affect nonunion rate in patients undergoing primary, open ankle arthrodesis. Additionally, inclusion of the distal tibio-fibular joint does not affect rate of wound complication, time to union, and DVT/PE rate.
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Ruan, Zhiyong, C. Luo, Z. Shi, B. Zhang, B. Zeng, and C. Zhang. "Intraoperative reduction of distal tibiofibular joint aided by three-dimensional fluoroscopy." Technology and Health Care 19, no. 3 (May 19, 2011): 161–66. http://dx.doi.org/10.3233/thc-2011-0618.
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Ramasamy, P., and A. Ward. "Distal tibiofibular joint dislocation with an intact fibula: a classification system." Injury 34, no. 11 (November 2003): 862–65. http://dx.doi.org/10.1016/s0020-1383(01)00193-0.
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O'Sullivan, E., G. Bowyer, and A. L. Webb. "The synovial fold of the distal tibiofibular joint: A morphometric study." Clinical Anatomy 26, no. 5 (August 7, 2012): 630–37. http://dx.doi.org/10.1002/ca.22140.
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Peter, R. E., R. M. Harrington, M. B. Henley, and A. F. Tencer. "Biomechanical Effects of Internal Fixation of the Distal Tibiofibular Syndesmotic Joint." Journal of Orthopaedic Trauma 8, no. 3 (June 1994): 215–19. http://dx.doi.org/10.1097/00005131-199406000-00006.
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Mavrogenis, Andreas F., Kleo T. Papaparaskeva, Spyros Galanakos, and Panayiotis J. Papagelopoulos. "Pigmented Villonodular Synovitis of the Distal Tibiofibular Joint: A Case Report." Clinics in Podiatric Medicine and Surgery 28, no. 3 (July 2011): 589–97. http://dx.doi.org/10.1016/j.cpm.2011.04.005.
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Clanton, Thomas O., Brady T. Williams, Jonathon D. Backus, Grant J. Dornan, Daniel J. Liechti, Scott R. Whitlow, Adriana J. Saroki, Travis Lee Turnbull, and Robert F. LaPrade. "Biomechanical Analysis of the Individual Ligament Contributions to Syndesmotic Stability." Foot & Ankle International 38, no. 1 (October 1, 2016): 66–75. http://dx.doi.org/10.1177/1071100716666277.
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Background: Biomechanical data and contributions to ankle joint stability have been previously reported for the individual distal tibiofibular ligaments. These results have not yet been validated based on recent anatomic descriptions or using current biomechanical testing devices. Methods: Eight matched-pair, lower leg specimens were tested using a dynamic, biaxial testing machine. The proximal tibiofibular joint and the medial and lateral ankle ligaments were left intact. After fixation, specimens were preconditioned and then biomechanically tested following sequential cutting of the tibiofibular ligaments to assess the individual ligamentous contributions to syndesmotic stability. Matched paired specimens were randomly divided into 1 of 2 cutting sequences: (1) anterior-to-posterior: intact, anterior inferior tibiofibular ligament (AITFL), interosseous tibiofibular ligament (ITFL), deep posterior inferior tibiofibular ligament (PITFL), superficial PITFL, and complete interosseous membrane; (2) posterior-to-anterior: intact, superficial PITFL, deep PITFL, ITFL, AITFL, and complete interosseous membrane. While under a 750-N axial compressive load, the foot was rotated to 15 degrees of external rotation and 10 degrees of internal rotation for each sectioned state. Torque (Nm), rotational position (degrees), and 3-dimensional data were recorded continuously throughout testing. Results: Testing of the intact ankle syndesmosis under simulated physiologic conditions revealed 4.3 degrees of fibular rotation in the axial plane and 3.3 mm of fibular translation in the sagittal plane. Significant increases in fibular sagittal translation and axial rotation were observed after syndesmotic injury, particularly after sectioning of the AITFL and superficial PITFL. Sequential sectioning of the syndesmotic ligaments resulted in significant reductions in resistance to both internal and external rotation. Isolated injuries to the AITFL resulted in the most substantial reduction of resistance to external rotation (average of 24%). However, resistance to internal rotation was not significantly diminished until the majority of the syndesmotic structures had been sectioned. Conclusion: The ligaments of the syndesmosis provide significant contributions to rotary stability of the distal tibiofibular joint within the physiologic range of motion. Clinical Relevance: This study defined normal motion of the syndesmosis and the biomechanical consequences of injury. The degree of instability was increased with each additional injured structure; however, isolated injuries to the AITFL alone may lead to significant external rotary instability.
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Palma, Joaquin, Jorge Filippi Nussbaum, Pablo Mery Ponce, Jorge Briceño, Andres Villa, and Mario Abarca. "Proximal Tibiofibular Joint Dislocation as a Maissoneuve Equivalent Fracture." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0003. http://dx.doi.org/10.1177/2473011417s000312.
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Category: Ankle, Trauma Introduction/Purpose: Dislocation of the proximal tibiofibular joint (PTFJ) in association with ankle fracture is an infrequent injury. The mechanism involves a pronation-external rotation injury in which the energy exits through the PTFJ instead of the proximal fibula, like in a Maissoneuve fracture. Early diagnosis and treatment is of paramount importance to avoid complications such as pain, posterolateral knee instability and peroneal nerve injury due to chronic traction by the dislocated fibular head. In addition, an anatomical reduction of the PTFJ is mandatory to restore the fibular length in order to obtain anatomic reduction at the ankle. The objective is to report 3 cases with PTFJ dislocation in association with ankle fracture and to provide a treatment guide based on the management of these patients. Methods: Three cases of PTFJ dislocation in association with ankle fracture, surgically treated in our institution between 2009 and 2016, were retrospectively analyzed. For each case, clinical history at admission, pre and post operative radiographs and computed tomography (CT) were obtained. Clinical follow up time was between 1 and 6 years. Results: Diagnosis of the PTFJ dislocation required a high degree of suspicion. All the patients had subtle radiographic abnormalities at the PTFJ, thus requiring a CT of the knee to confirm the diagnosis. The first surgical step was to perform an open reduction of the PTFJ. Common peroneal nerve was identified and retracted. Reduction was performed with a clamp and for fixation we used one cortical positioning screw from the fibula to the tibia. After the achievement of an anatomic reduction, the second step was to approach the ankle according the specific fracture pattern. Anatomical reduction was obtained in all the patients checked by ankle and knee CT. At final follow up none of the patients had knee pain, and all returned to their activities. Conclusion: The PTFJ dislocation in association with ankle fracture is an infrequent injury and should be considered as a Maissoneuve equivalent fracture in terms of mechanism and diagnosis. A high index of suspicion is needed and the diagnosis is confirmed with a knee CT. As the Essex Lopresti injury of the upper extremity, this type of lesion requires proximal and distal stabilization. Our recommended treatment, based on the good clinical results of our 3 patient, is open reduction and screw fixation of the PTFJ as the first step in order to allow anatomical reduction of the distal injury at the ankle.
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Grass, Rene, Stefan Rammelt, Achim Biewener, and Hans Zwipp. "Peroneus Longus Ligamentoplasty for Chronic Instability of the Distal Tibiofibular Syndesmosis." Foot & Ankle International 24, no. 5 (May 2003): 392–97. http://dx.doi.org/10.1177/107110070302400503.
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The distal tibiofibular syndesmosmotic ligament complex is important for dynamic stability and congruency of the ankle joint. Syndesmotic lesions in the ankle fracture-dislocations are well recognized and classified systematically. Chronic insufficiency of the syndesmosis leads to a lateral shift of the talus and under eversion stress permits a pathological rotation of the talus. There is also retroversion of the distal fibula representing a painful deformity. Little experience exists with surgical reconstruction of the syndesmosis. This article describes a new ligamentoplasty with a split peroneus longus tendon graft that mimics the normal anatomic conditions of the syndesmotic complex in 16 patients with symptomatic chronic syndesmotic insufficiency after pronation-external rotation and pronation abduction injuries to the ankle joint. Postoperatively, no infections or hematomas were seen. One patient had asymptomatic breakage of the syndesmosis screw; one patient had a 10° decrease of dorsiflexion at the ankle because of a partial anterior tibiofibular synostosis. Fifteen of 16 patients had pain relief at a mean follow-up period of 16.4 months (range, 13–29 months); all patients had relief of the chronic swelling of the ankle and the giving way. The mean Karlsson score at follow-up was 88 (range, 70–100) points. It may be concluded that peroneus longus ligamentoplasty in a preliminary series resulted in reliable ankle stability and considerable pain relief in patients with chronic syndesmotic instability.
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Wei, Xiang-Ke, Guang-Wu Jing, Yang Shu, Jie Tong, and Jin-Hua Wang. "Self-made wire-rope button plate: A novel option for the treatment of distal tibiofibular syndesmosis separation." Journal of Orthopaedic Surgery 29, no. 1 (January 1, 2021): 230949902097521. http://dx.doi.org/10.1177/2309499020975215.
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Objective: To compare the clinical effect of the self-made wire-rope button plate and cortical screw in the treatment of the distal tibiofibular syndesmosis separation. Methods: Total 26 patients with distal tibiofibular syndesmosis separation were treated with internal fixation with a self-made wire-rope button plate and cortical screw. They were divided into a self-made wire-rope button plate group and cortical screw group. self-made wire-rope button plate group: 12 cases of inferior tibiofibular syndesmosis were reconstructed by self-made wire-rope button plate. Cortical screw group: 14 cases of inferior tibiofibular syndesmosis were reconstructed by cortical screw. The follow-up data of 2, 6, 12 weeks and 6 and 12 months after operation were collected. Results: There was no significant difference in operative time, the amount of intraoperative bleeding and postoperative complications between the two groups (P > 0.05). Comparison of postoperative complications: There was no loosening and rupturing of internal fixation in the self-made wire-rope button plate group. In the cortical screw group, the rupture of screws was found in 1 case, which occurred in the 10th weeks after the operation, and the broken screws were removed after 1 year with other internal fixations. Within 12 weeks of reoperation to remove the internal fixation rate: There was a significant difference in the rate of reoperation to remove the internal fixation within 12 weeks (p < 0.05). At the last follow-up, the AOFAS score of the ankle joint were 94 ± 4.79 in the self-made wire-rope button plate group and 92.8 ± 6.73 in the cortical screw group. There was no significant difference (P > 0. 05). Conclusion: The self-made wire-rope button plate and cortical screw can effectively treat the separation of the tibiofibular syndesmosis. It provides a new choice for the treatment of inferior tibiofibular syndesmosis.
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Ebraheim, Nabil A., Anis O. Mekhail, and Scott S. Gargasz. "Ankle Fractures Involving the Fibula Proximal to the Distal Tibiofibular Syndesmosis." Foot & Ankle International 18, no. 8 (August 1997): 513–21. http://dx.doi.org/10.1177/107110079701800811.
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Thirty-two cases of ankle fractures associated with fibular fractures above the distal tibiofibular syndesmosis were studied. All were treated with open reduction and internal fixation. The average follow-up was 25 months. The results of the postoperative evaluation were rated, based on subjective clinical criteria, as good, fair, and poor. According to the Lauge-Hansen classification, there were 17 (53%) cases of supination-external rotation injury (2 stage 2 and 15 stage 4), 9 (28%) cases of stage 3 pronation-abduction injury, and 6 (19%) cases of pronation-external rotation injury (3 stage 3 and 3 stage 4). All cases could be classified as Weber type C or as suprasyndesmotic, fibular diaphyseal fracture (44-C) according to the Orthopaedic Trauma Association classification. In 18 (56%) cases, the fracture was associated with ankle dislocation. There were seven (22%) open fractures (two grade I, four grade II, and one grade IIIA). Syndesmotic screws were used in 23 (72%) cases (12 supination-external rotation injury, 6 pronation-external rotation injury, and 5 pronation-abduction injury). The syndesmotic screw was removed after an average of 9 weeks. Four (13%) nonunions and two (6%) delayed unions of the fibula were treated with bone grafting and/or hardware revision and eventually healed. Three of the nonunions had poor clinical results because of degenerative ankle joint arthritis in two (one of them ended in arthrodesis) and deep infection, which was eventually cured, in the third. The fourth nonunion had a fair result. One of the delayed unions had a fair result (an obese patient) and the other had a good result. Two patients developed deep infections; one ended in gangrene and amputation in a diabetic patient, and the other was a patient with fibular nonunion that eventually healed. Three patients had superficial infections that were treated successfully. Of the 32 cases, 23 (72%) showed good results, 4 (13%) showed fair results, and 5 (16%) showed poor results. The cases with poor results included three fibular nonunions, one deep infection, and one recurrent superficial infection and wound dehiscence after hardware removal. A syndesmotic screw is usually needed in cases of fracture-dislocations. Two patients with occult fibular nonunions developed diastasis of the syndesmosis after removal of the syndesmotic screw. It was found that reduction and temporary pinning of the distal tibiofibular joint helps achieve fibular length, which is crucial to restoring the biomechanics of the ankle joint. It seems advisable not to remove the syndesmotic screw until there are signs of healing of fibular fracture to avoid diastasis of the distal tibiofibular joint. Bone grafting should be considered in high energy fractures with comminution. These complex injuries are associated with higher rates of complications. Poor results can be attributed to fracture factors, e.g., open fractures, infections; patient factors, e.g., obesity, lowered immunity as in diabetes, and noncompliance; and iatrogenic factors, e.g., early removal of syndesmotic screws.
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Abdelaziz, Mohamed, Jafet Massri-Pugin, Bart Lubberts, Bryan Vopat, Daniel Guss, Ali Hosseini, Christopher DiGiovanni, and Anne Holly Johnson. "Arthroscopic Characterization of Syndesmotic Instability." Foot & Ankle Orthopaedics 3, no. 2 (April 19, 2018): 2473011418S0000. http://dx.doi.org/10.1177/2473011418s00002.
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Category: Arthroscopy, Sports, Trauma, Other, Syndesmosis Introduction/Purpose: Ankle arthroscopy is increasingly used to diagnose syndesmostic instability by visualizing the distal tibiofibular articulation and applying a lateral fibular stress. Precisely where in the incisura one should measure potential diastasis, however, remains unclear. The purpose of this study was to determine where within the incisura one should assess coronal plane instability in purely ligamentous syndesmotic injuries when performing a lateral hook stress test (LHT). Methods: Twenty-two above-knee cadaveric specimens underwent ankle arthroscopy, first with intact ligaments and thereafter after each sequential step of syndesmotic and deltoid ligament transection. At each step, a standard 100 N hook test was applied through a lateral incision 5 cm proximal to the ankle joint and the coronal plane diastasis in the stressed and unstressed states were measured at both anterior and posterior third of the distal tibiofibular joint using calibrated probes ranged from 0.1 to 6.0 mm, with 0.1 mm of increments. Results: Anterior third diastasis did not change significantly when applying a LHT, neither in the intact state nor after any stage of ligament transection (P values ranging from p=0.61 to p=0.94). In contrast, posterior third diastasis increased significantly by applying stress at the intact state at the following stages of transection: posterior-inferior tibiofibular ligament (PITFL), PITFL plus interosseous ligament, all syndesmosis ligaments, and all syndesmosis ligaments plus superficial and deep deltoid ligament (P values ranging p=0.001 to p=0.031). Interobserver agreement was substantial (ICC = 0.81; 95% confidence interval, 0.44-0.92), and moderate (ICC = 0.73; 95% confidence interval, 0.36-0.87) for anterior and posterior third diastasis measurements, respectively. Conclusion: Syndesmotic ligament injury results in coronal plane instability of the distal tibiofibular articulation that is readily identified arthroscopically with a LHT and when measured in the posterior third of the incisura. Measurement at the anterior third of the incisura may miss such injuries.
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Lee, Young Koo, and Jungwoo Yoo. "Open syndesmotic repair for open-book type syndesmotic injury." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0031. http://dx.doi.org/10.1177/2473011418s00316.
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Category: Trauma Introduction/Purpose: Although there are several approaches to the treatment of syndesmosis injury, there is no gold standard technique. Syndesmotic screw fixation is one of commonly used treatment options but there remains debate topics such as implant breakage and the need for device removal. The purpose of this study was to evaluate the clinical, radiologic and arthroscopic outcomes of open syndesmotic repair for open-book type syndesmotic injury as a new treatment option. Methods: We reviewed the clinical, radiographic and arthroscopic results of 20 patients with traumatic injuries to the distal tibiofibular syndesmosis who were treated with open syndesmotic repair. Arthroscopic evaluations including cotton test were performed at the primary and second-look operation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score and visual analog scale (VAS) score were used to evaluate clinical outcomes. The measurement of the tibiofibular clear space and tibiofibular overlap were used to evaluate radiologic outcomes. Both Clinical and radiologic outcome evaluations were performed preoperatively, at 6 weeks and 6 months postoperatively, and at a final follow-up at a minimum 12 months postoperatively. The average follow-up period was 15.3 months. Results: The average AOFAS score improved from 45.4 (range 30-68) preoperatively to 94.12 (range 83-100) at the last follow-up (P < .001). The radiologic parameters of the syndesmosis returned to normal range since the first postoperative follow-up. At second-look arthroscopy, all the patients showed negative cotton test results and the gap of distal tibiofibular joint was remained less than 2 mm in all patients. Conclusion: We had excellent clinical, radiologic and arthroscopic results and there is no major complication. Open syndesmotic repair for open-book type syndesmotic injury is effective in healing and maintaining the injured joint. Therefore this procedure could be a reasonable alternative treatment for traumatic syndesmosis injury of the ankle.
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Baek, Jong Hun, Tae Yong Kim, Yoo Beom Kwon, and Bi O. Jeong. "Radiographic Change of the Distal Tibiofibular Joint Following Removal of Transfixing Screw Fixation." Foot & Ankle International 39, no. 3 (December 26, 2017): 318–25. http://dx.doi.org/10.1177/1071100717745526.
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Background: Syndesmosis disruptions in the ankle joint are typically treated with anatomic reduction followed by transfixing screw and/or suture button fixation. The purpose of our study was to analyze the effects of the removal of transfixing screws on syndesmosis integrity using plain radiographs and computed tomography (CT) scans. Methods: Twenty-nine cases (29 patients) who had been treated with transfixing screw fixation for syndesmosis disruptions were studied prospectively. Plain radiographs and CT scans were obtained 1 day before and 3 months after the removal of transfixing screws. The tibiofibular clear space (TCS) and tibiofibular overlap (TFO) were measured on plain radiographs, and the anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT scans to radiographically analyze the effect of the removal of screws on syndesmosis integrity. Results: On plain radiographs, syndesmosis diastasis was not observed before or after the removal of transfixing screws. No statistically significant difference was found in the TCS and the TFO between measurements at prescrew removal and at postscrew removal ( P = .761 and .628, respectively). However, the syndesmosis was found malreduced on CT scans in 7 cases (24.1%) before screw removal. All 7 cases showed anterior malreduction of the syndesmosis, 5 (71.4%) of which spontaneously reduced after screw removal. The A/P ratio of the 7 cases decreased from a mean of 1.37 (range, 1.26-1.61) at prescrew removal to a mean of 1.12 (range, 0.96-1.25) at postscrew removal ( P = .016). Conclusion: Syndesmosis malreduction not observed on plain radiographs after performing transfixing screw fixation was identified with CT scans. Of the cases with a malreduced syndesmosis, 71.4% showed spontaneous reduction after screw removal. Therefore, we believe the removal of transfixing screws is recommended after confirming malreduction on CT scans, although plain radiographs demonstrate anatomic reduction. Level of Evidence: Level II, prospective prognostic study.
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Hwang, John S., Michael S. Sirkin, Zachary Gala, Mark Adams, and Mark C. Reilly. "Concomitant Proximal and Distal Tibiofibular Joint Dislocation Associated With a Tibial Shaft Fracture." Journal of the American Academy of Orthopaedic Surgeons 26, no. 15 (August 2018): e329-e332. http://dx.doi.org/10.5435/jaaos-d-17-00159.
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Ciampolini, Jacopo, Martin F. Gargan, and John H. Newman. "Arthrodesis of the Distal Tibiofibular Joint for a Large Osteochondroma in an Adult." Foot & Ankle International 20, no. 10 (October 1999): 657–58. http://dx.doi.org/10.1177/107110079902001008.
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Lepojärvi, Sannamari, Jaakko Niinimäki, Harri Pakarinen, and Hannu-Ville Leskelä. "Rotational Dynamics of the Normal Distal Tibiofibular Joint With Weight-Bearing Computed Tomography." Foot & Ankle International 37, no. 6 (February 27, 2016): 627–35. http://dx.doi.org/10.1177/1071100716634757.
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Honda Saito, Guilherme, Marcelo Pires Prado, Alberto Abussamra Moreira Mendes, Danilo Ryuko Nishikawa, Beatriz Devito, and Leticia Devito. "PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button." Scientific Journal of the Foot & Ankle 13, Supl 1 (November 11, 2019): 43S. http://dx.doi.org/10.30795/scijfootankle.2019.v13.1031.
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Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.
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Trojani, M. C., and B. Le Goff. "AB1135 ECHO-ANATOMY OF THE PROXIMAL TIBIOFIBULAR JOINT." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1857.1–1858. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3929.
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Background:The proximal tibiofibular joint (PFTJ) should be considered in the differential diagnosis of a patient presenting with complaints in the lateral aspect of the knee However, this joint is often forgotten, yet involved in many degenerative and inflammatory pathological processes. MRI remains the imaging of choice to study the PFTJ. Ultrasound could also be useful in clinical practice to study the joint and its environment. To our knowledge, there is no systematic descriptive echo-anatomical study of PFTJ that would allow to standardize the ultrasound scanning of this joint.Objectives:The objective of our study was to describe standardized ultrasonographic scans of the PTF joint and its environment starting from an anatomical study of the joint and then confirming the visibility of the different structures on a series of healthy volunteers.Methods:We first conducted an anatomical study of the PTFJ on 3 cadavers. The different part of the joint (capsule, cartilage, ligaments) and the environment (nerves, muscles, vessels) were studied allowing an exact correlation between US images and the structures. This step led us to choose 3 scans useful for the study of the different part of the joint in clinical practice (figure 1): an anterior transverse oblique, a strict coronal, and a posterior transverse oblique. Subsequently, a TFPJ ultrasound was performed on 20 healthy volunteer patients to evaluate the feasibility and the visibility of the different structures seen on the dissection part.Figure 1.Results:The different structures seen on the anterior transverse oblique scan were the anterior joint space, cartilage and anterior proximal tibiofibular ligament. The coronal approach led us to the visualization of the joint space, the collateral lateral ligament, the inferolateral genicular and posterior tibial recurrent artery, the meniscus and more posteriorly the ligaments of the posterolateral corner (popliteofibular, arcuate and fabellofibular). Finally, the posterior transverse oblique allowed us to study the posterior ligaments and joint recess under the soleus muscle. Twenty healthy volunteers with an average age of 29 years underwent an ultrasound of the right PTF joint. The joint line spacing was visualized in 100% of the cases on the 3 sections. The anterior cross-section allowed anterior proximal tibiofibular ligament analysis in 100% of the cases (median length 15,7 mm (min-max: 12.3 – 23.4), median thickness 1.4 mm (min-max: 1-2.3). The coronal section allowed identification of the inferolateral geniculate and posterior tibial recurrent arteries in 90 and 85% of cases respectively, and the distal insertion of the fibular collateral ligament in 100% of cases. Posterior sectioning was more challenging and identification of the popliteal tendon, arcuate ligament and posterior proximal tibiofibular ligament was possible in 16, 7 and 2 patients respectively.Conclusion:We performed a 2-step study: a cadaveric study followed by an ultrasound on healthy volunteer which allowed us to define 3 standardized scan of the PTF joint. These sections allow a thorough study of the PTF joint and the surrounding structures although study of the posterolateral corner ligaments remains challenging. We think that this scanning method can be integrated into daily clinical practice in rheumatology and in sports medicine.Disclosure of Interests:None declared
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Ataoğlu, Muhammet Baybars, Mehmet Ali Tokgöz, Anıl Köktürk, Yılmaz Ergişi, Mustafa Yasin Hatipoğlu, and Ulunay Kanatlı. "Radiologic Evaluation of the Effect of Distal Tibiofibular Joint Anatomy on Arthroscopically Proven Ankle Instability." Foot & Ankle International 41, no. 2 (October 31, 2019): 223–28. http://dx.doi.org/10.1177/1071100719884555.
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Background: Ankle sprains occur frequently in both athletes and the general population. The social and economic consequences can be significant. In an effort to understand the injury, dynamic and static structures around the ankle have been investigated in detail, but anatomical factors predisposing to lateral ankle instability have not been fully clarified. The aim of this study was to radiologically investigate the relationship between bony variations of the distal tibiofibular joint and arthroscopically proven ankle instability. Methods: Fifty patients with arthroscopically proven ankle instability and 50 patients without instability were included in this study. Measurements were obtained from a magnetic resonance imaging (MRI) section 1 cm proximal to the tibiotalar joint; distal tibiofibular joint anterior facet length ( a), posterior facet length ( b), angle between the anterior and posterior facets ( c), fibular notch depth ( d), tibia thickness ( e), and fibula thickness ( f) was measured. Results: It was found that instability was more frequent when the length of a ( P < .001) and e ( P < .001) were shorter. In addition, when value of a/ b and e/f were evaluated, it was observed that the number of individuals who had instability increased as the ratio became smaller ( P < .016-.020, respectively). Pearson correlation analysis indicated strong negative correlation between the values of a- e and instability ( r = −0.348, P < .001, and r = −0.328, P = .001; respectively). Conclusion: Lateral ankle sprains are common, and a clear understanding of the relevant structures and clinical function of the ankle complex should extend beyond the talocrural joint. This study demonstrated that the presence of narrow anterior facet ( a) and thinner tibia ( e) were strongly correlated with lateral ankle instability. Level of Evidence: Level III, retrospective case control study.
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Song, Daniel J., Joseph T. Lanzi, Adam T. Groth, Matthew Drake, Joseph R. Orchowski, Steven H. Shaha, and Kenneth K. Lindell. "The Effect of Syndesmosis Screw Removal on the Reduction of the Distal Tibiofibular Joint." Foot & Ankle International 35, no. 6 (February 14, 2014): 543–48. http://dx.doi.org/10.1177/1071100714524552.
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Lee, Ching-Yin, and Yu-Chiang Chen. "Anterior fibular dislocation of the distal tibiofibular joint with lateral diastasis of the ankle." Formosan Journal of Musculoskeletal Disorders 2, no. 2 (May 2011): 71–74. http://dx.doi.org/10.1016/j.fjmd.2011.03.007.
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Demiralp, Bahtiyar, Mahmut Komurcu, Cagatay Ozturk, Kutay Ozturan, Ersin Tasatan, and Kaan Erler. "Acute Traumatic Open Posterolateral Dislocation of the Ankle Without Tearing of the Tibiofibular Syndesmosis Ligaments." Journal of the American Podiatric Medical Association 98, no. 6 (November 1, 2008): 469–72. http://dx.doi.org/10.7547/0980469.
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Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5° in dorsiflexion, 10° in plantarflexion, 5° in inversion, and 0° in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability. (J Am Podiatr Med Assoc 98(6): 469–472, 2008)
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Amin, Arsalan, Cory Janney, Christopher Sheu, Daniel C. Jupiter, and Vinod K. Panchbhavi. "Weight-Bearing Radiographic Analysis of the Tibiofibular Syndesmosis." Foot & Ankle Specialist 12, no. 3 (April 1, 2018): 211–17. http://dx.doi.org/10.1177/1938640018766631.
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Background: Diagnosis of distal tibiofibular syndesmotic injuries includes assessment of radiographs; however, there exist no agreed on standard diagnostic criteria. Previous studies lack consistency with radiographic evaluation methods. The dynamic nature of the ankle joint supports analyzing anatomical parameters using weight-bearing films to assess for tibiofibular syndesmotic integrity. Methods: Weight-bearing tibiofibular syndesmosis radiographs of 39 male and 40 female patients were retrospectively analyzed by 3 investigators, at different levels of orthopaedic training. Measurements 1 cm above the tibial plafond for the anterior tibiofibular overlap (TFO) and tibiofibular clear space (TCS) were recorded and standardized by the fibular width (FW) at 2 time points. Data were compared to check for agreement between the sets of measurements for each rater and agreement between investigators, and to ascertain underlying gender differences. Results: There was good intraobserver correlation (intraclass correlation coefficient [ICC] > 0.90) among investigators for each parameter. A significant difference in the TFO was noted between genders (P < .05). We establish the following radiographic (anteroposterior view) parameters for an intact syndesmosis: male patients, TCS <4.57 mm or TCS/FW <29% and TFO >9.29 mm or TFO/FW > 57%; female patients, TCS <4.28 mm or TCS/FW <30% and TFO >7.41 mm or TFO/FW >51%. Conclusions: Our study provides a more objective approach by utilizing weight-bearing radiographs and performing all measurements 1 cm above the tibial plafond. Levels of Evidence: Level IV
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Hagemeijer, Noortje, Song Ho Chang, Mohamed Abdelaziz Elghazy, Gregory Waryasz, Daniel Guss, and Christopher DiGiovanni. "Normal Variation and Instability Values of the Tibiofibular Joint on Weightbearing CT." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0019. http://dx.doi.org/10.1177/2473011419s00196.
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Category: Ankle Introduction/Purpose: Prompt management of syndesmotic instability is critical for optimizing clinical outcome, but subtle injuries may be difficult to diagnose. Application of modern imaging modalities such as weight bearing CT (WBCT) may better identify such injuries by virtue of assessing the distal tibiofibular articulation under physiologic load. The aim of this study was to evaluate the distal tibiofibular articulation using WBCT among patients with known syndesmotic instability and compare these findings with their uninjured contralateral sides, and thereafter corroborate such measurement differences with patients devoid of any syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring surgical fixation (n=12) underwent bilateral ankle WBCT that incorporated the entire foot. A separate cohort of patients without ankle injury also underwent bilateral ankle WBCT for assessment of either a Lisfranc injury or forefoot condition (n=24). All WBCT imaging was performed preoperatively. A set of five axial plane tibiofibular joint measurements including one angular measurement were standardly assessed one cm above the tibial plafond. Values were recorded by two independent observers to assess for interobserver reliability scores. Interpretation of the intraclass correlation coefficients was carried out according to the guidelines proposed by Shrout: 0.00-0.10 virtually none, 0.11-0.40 slight, 0.41-0.60 fair, 0.61-0.80 moderate, 0.81 -1.00 substantial. Results: Among the control population without ankle injury, no differences were found between bilateral measurements (p-value range 0.172 - 0.961). Among those with known unilateral syndesmotic instability, values differed between the injured and uninjured side in five of six measurements— including syndesmotic area, direct anterior-, middle-, and posterior- difference, and sagittal translation (p <0.001, <0.001, <0.001, <0.001, 0.039, respectively). Those same measurements also differed when comparing the left-right delta values between uninjured and injured patients (p <0.001, 0.002, <0.001, <0.001, and 0.042, respectively). Fibular rotation differed neither in direct nor delta comparisons (p=0.460 and 0.271 respectively). Substantial agreement was found for all measurements except for sagittal translation, which had only slight agreement. Conclusion: This study highlights the ability of WBCT to effectively differentiate syndesmotic diastasis and fibular translation among patients with surgically-confirmed syndesmotic instability as compared to those without syndesmotic instability. It also underscores the importance of using the contralateral, uninjured side as a valid internal control. Additional studies are necessary to better understand the role of WBCT in prospectively diagnosing more subtle cases of syndesmotic instability among patients for whom the diagnosis remains in question.
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Gough, Brandon E., Alexander C. M. Chong, Steven J. Howell, Joseph W. Galvin, and Paul H. Wooley. "Novel Flexible Suture Fixation for the Distal Tibiofibular Syndesmotic Joint Injury: A Cadaveric Biomechanical Model." Journal of Foot and Ankle Surgery 53, no. 6 (November 2014): 706–11. http://dx.doi.org/10.1053/j.jfas.2014.04.022.
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D’Hooghe, Pieter, Monique C. Chambers, MaCalus V. Hogan, Volker Musahl, Khalid Alkhelaifi, Tabben Montassar, Freddie H. Fu, and Jean-Francois Kaux. "Determining the force required in arthroscopic evaluation to assess the stability of syndesmotic ankle injury: a cadaveric study." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 4, no. 2 (February 3, 2019): 100–104. http://dx.doi.org/10.1136/jisakos-2017-000183.
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IntroductionThe diagnosis of isolated distal tibiofibular syndesmotic ankle instability proves to be a challenge. Although diagnostic imaging has added value, it is limited in the detection of distal syndesmotic ankle instability. The gold standard remains intraoperative testing through arthroscopic probing while externally stressing the ankle in a sagittal direction. However, no validated arthroscopic guidelines have been established to distinguish a stable from an unstable syndesmotic ankle joint. This cadaveric study presents anatomical and biomechanical data that can help surgeons correctly identify isolated distal syndesmotic ankle instability.ObjectiveThe purpose of this study is to quantify the necessary forces applied during ankle arthroscopy to evaluate syndesmotic instability in freshly frozen cadaveric ankles.MethodsA total of 16 fresh frozen cadaveric (age 58–74 years) ankles were included in the study. A dynamometer was used to measure the force necessary for the shaver tip to be inserted into the distal tibiofibular joint with the ankle in a neutral position. Measurements were performed first with the syndesmosis intact, and again following progressive transection of the syndesmotic ligaments, along with distal fixation.ResultsSignificant differences were noted in the mean force required between the anterior inferior tibiofibular ligament (AITFL)+interosseous ligament (IOL) and no ligament cut methods (p<0.001 between the AITFL+IOL and AITFL cut (p<0.001; 95% CI 44.80 to 50.70), and between the AITFL+IOL and AITFL+IOL+ PITFL cut (p<0.001). There were also significant differences in the necessary mean forces applied between the one-SB and two-SB methods (p<0.001), between the one-SB and one-screw methods (p=0.010), between the one-SB and two-screw methods (p=0.01), between the two-SB and two-screw methods (p=0.003) and between the one-screw and two-screw methods (p<0.001). Significant differences were found between the AITFL+IOL cut and the one-SB (p<0.001), the two-SB (p<0.001), the one-screw (p<0.001) and the two-screw (p<0.001) methods.ConclusionsThis cadaveric study provides biomechanical data that can assist the surgeon in the arthroscopic evaluation of syndesmotic injuries. The data from this study need to be clinically correlated to ultimately assist in improving the outcome of patients with syndesmotic ankle injuries. Our study offers to bridge the gap to the development of arthroscopic tools that can identify the need for surgical fixation to the syndesmosis based on the laxity of specific ankle ligaments that contribute to subtle instability.Level of evidenceLevel V cadaveric study.
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Khambete, Pranav, Ethan Harlow, Jason Ina, and Shana Miskovsky. "Biomechanics of the Distal Tibiofibular Syndesmosis: A Systematic Review of Cadaveric Studies." Foot & Ankle Orthopaedics 6, no. 2 (January 1, 2021): 247301142110127. http://dx.doi.org/10.1177/24730114211012701.
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Background: This investigation’s purpose was to perform a systematic review of the literature examining the biomechanics of the ligaments comprising the distal tibiofibular syndesmosis with specific attention to their resistance to translational and rotational forces. Although current syndesmosis repair techniques can achieve an anatomic reduction, they may not reapproximate native ankle biomechanics, resulting in loss of reduction, joint overconstraint, or lack of external rotation resistance. Armed with a contemporary understanding of individual ligament biomechanics, future operative strategies can target key stabilizing structure(s), translating to a repair better equipped to resist anatomic displacing forces. Study design: Systematic review. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using a PRISMA checklist. Biomechanical studies testing cadaveric lower limb specimens in the intact and injured state measuring the distal tibiofibular syndesmosis resistance to translational and rotational forces were included in this review. Only studies that included numerical data were included in this review; studies that only reported figures and graphs were excluded. Results: Twelve studies met the inclusion and exclusion criteria. Two studies determined the mechanical properties of syndesmotic ligaments, finding superior strength and stiffness of the interosseous ligament (IOL), as compared to the anterior (AITFL) or posteroinferior tibiofibular ligament (PITFL). Four studies examined native ankle biomechanics establishing physiologic range of motion of the fibula relative to the tibia. Fibular range of motion was found to be up to 2.53 mm of posterior translation (Markolf et al), 1.00 mm lateral translation (Xenos et al), 3.6 degrees of external rotation (Burssens et al), and 1.4 degrees of internal rotation (Clanton et al). Four studies evaluated syndesmotic biomechanics under physiological loading and found that the AITFL, IOL, and PITFL provide the majority of resistance to external rotation, diastasis, and internal rotation, respectively. Two studies investigated the biomechanics of clinically and intraoperatively used tests for syndesmotic injuries and found increased sensitivity of sagittal plane posterior fibular translation, as opposed to coronal plane lateral fibular translation for unstable injuries. Conclusions: Study findings suggest that although the IOL is the strongest syndesmotic ligament, the AITFL has a dominant role stabilizing the distal tibiofibular syndesmosis to external rotation force. Because of these characteristics, operative repair of the AITFL along its native vector may provide a more biomechanically advantageous construct and should be investigated clinically. Additionally, evaluation of clinical stress tests revealed that the external rotation stress test is the most sensitive test to recognize an AITFL tear, and that a 3-ligament disruption is needed to cause diastasis greater than 2 mm.
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Sørensen, Brian Weng, and Peter Mikkelsen. "Arthrodesis of the Distal Tibiofibular Joint for an Osteochondroma in the Fibula Encroaching on the Distal Tibia and Involving the Talocrural Joint: A Case Report." Journal of Foot and Ankle Surgery 51, no. 5 (September 2012): 664–65. http://dx.doi.org/10.1053/j.jfas.2012.05.014.
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Marsil, Hafni, Rizki Rahmadian, Sylvia Rachman, and Erkadius Erkadius. "ANTROPOMETRI SENDI PERGELANGAN KAKI ETNIS MINANGKABAU." Majalah Kedokteran Andalas 38, no. 2 (December 8, 2015): 108. http://dx.doi.org/10.22338/mka.v38.i2.p108-115.2015.
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AbstrakPenelitian ini bertujuan mengukur antropometri sendi pergelangan kaki etnis Minangkabau. Penelitian cross sectional dilakukan pada 50 orang mahasiswa kedokteran etnis Minangkabau berusia 21-25 tahun di lingkungan RS. dr. M Djamil Padang. Dilakukan pemeriksaan ROM, rontgen ankle proyeksi anteroposterior, lateral dan mortise. Hasil penelitian didapatkan ROM plantarfleksi 48,920±5,820, ROM dorsofleksi 31,300±4,070, inversi 10,320±2,280, eversi 5,940±1,200, talocrural angel anteroposterior 76,530± 2,530 dan mortise 77,380±2,270, tibiofibular overlap anteroposterior 7,51±2,64 mm dan mortise 4,71±2,45 mm, tibiofibular clear space anteroposterior 3,6±1,18 mm dan mortise 3,85±1,09 mm, talar tilt anteroposterior 0,140±0,100 dan mortise 0,190±0,150, medial malleolar length anteroposterior 13,88±1,99 mm dan mortise 14,03±1,69 mm, lateral malleolar length anteroposterior 25,71±2,83 mm dan mortise 26,70±3,40 mm, johnson angle anteroposterior 87,770±1,710 dan mortise 87,570±1,840, medial clear space 2,97±0,75 mm, anteroposterior inclination angle 7,470±2,700, anterior distal tibial angle 82,530± 2,700, dan anteroposterior gap 3,50±1,43 mm.Terdapat perbedaan ukuran antropometri sendi pergelangan kaki mahasiswa kedokteran beretnis Minangkabau di lingkungan RS. Dr. M. Djamil Padang dengan kepustakaan, namun masih dalam rentang normal.AbstractThis study aimed to measure anthropometric of ankle joint of Minangkabau ethnic group. Cross sectional study has been done in 50 Minangkabau ethnic medical students, aged 21-25 years in RSUP. Dr. M Djamil Padang. ROM, anteroposterior, lateral, and mortise X-ray projections of ankle were examined. ROM plantarflexion was 48.920±5.820, ROM dorsiflexion was 4.070±31.300, inversion was 10.320±2.280, eversion was 5.940±1.200, talocrural angel anteroposterior was 76.530±2.530 and mortise was 77.380±2.270, tibiofibular overlapp anteroposterior was 7.51±2,64 mm and mortise was 4.71±2,45 mm, tibiofibular clear space anteroposterior was 3.6±1.18 mm and mortise was 3.85±1.09 mm, talar tilt anteroposterior was 0.140 ± 0.100 and mortise was 0.190 ± 0.150, medial malleolar length anteroposterior was 13.88 ± 1,99mm and mortise was 14.03 ± 1,69mm, lateral length malleolar anteroposterior was 25.71±2,83 mm and mortise was 26.70 ± 3,40 mm, johnson angle anteroposterior was 87.770 ± 1.710 and mortise was 87.570±1.840, medial clear Space was 2,97±0,75 mm, anteroposterior Inclination Angle was 7.470±2.700, anterior distal tibial Angle was 82.530 ± 2.700 and anteroposterior gap was 3.50 ± 1,43 mm. There was a difference in antropometric size of the ankle joint between Minangkabau ethnic medical student in RSUP. Dr. M. Djamil Padang and literature, but still within the normal range.
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Kocadal, Onur, Mehmet Yucel, Murad Pepe, Ertugrul Aksahin, and Cem Nuri Aktekin. "Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries." Foot & Ankle International 37, no. 12 (August 20, 2016): 1317–25. http://dx.doi.org/10.1177/1071100716661221.
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Background: Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. Methods: Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. Results: There was a statistically significant decrease in the degree of fibular rotation ( P = .03) and an increase in the upper syndesmotic area ( P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area ( P = .02) and distal tibiofibular volumes ( P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. Conclusion: Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique. Level of Evidence: Level III, retrospective comparative study.
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Garcia-Vilariño, Elena, Alberto Perez-Garcia, Enrique Salmeron-Gonzalez, Alberto Sanchez-Garcia, Jose Luis Bas, and Eduardo Simon-Sanz. "Avoiding Above-the-Knee Amputation with a Free Tibiofibular–Talocalcaneal Fillet Flap and Free Latissimus Dorsi Flap." Indian Journal of Plastic Surgery 53, no. 01 (March 2020): 135–39. http://dx.doi.org/10.1055/s-0040-1708226.
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AbstractDespite the advances achieved in reconstructive surgery, amputation is still the only option after some severe traumas. Preservation of the knee joint is considered a significant functional advantage. We present the case of a 39-year-old man with a comminuted Gustilo type IIIC open tibia fracture with massive bone loss. To achieve a well-fashioned amputation stump and preserve the knee joint, a free osteocutaneous fillet flap was performed, including the distal tibia and fibula, talus, and calcaneus bones. As a result, a sensate and long amputation stump covered with thick skin from the sole of the foot provided a stable coverage with an excellent functional result and adjustment to prosthesis.
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DiDomenico, Lawrence, and Danielle Butto. "20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000159.
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Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.
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Bartolomei, Jonathan, Mark W. Bowers, and Kenneth J. Hunt. "Kinematics after Syndesmotic Injury: Assessing the Magnitude of Talus and Fibula Rotation and Displacement." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0011. http://dx.doi.org/10.1177/2473011420s00114.
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Category: Ankle; Sports; Other Introduction/Purpose: High ankle sprains, or injuries to the distal tibiofibular syndesmosis, are predictive of long-term ankle dysfunction. Our objectives were to evaluate ankle mortise stability, radiographically, and kinematically, using a cadaveric model with a simulated syndesmotic injury. We also measured the ability of a suture-button system to restore natural joint motion. Methods: Eight cadaveric specimens underwent serial sectioning of the anterior-inferior tibiofibular (AITFL), interosseous (IOL), posterior-inferior tibiofibular (PITFL), and deltoid ligaments. Specimens underwent external rotation and lateral translation testing after ligament release to obtain kinematic data (using a validated infrared LED motion capture system) and radiographic measurements. We then repeated external rotation and lateral translation testing after implementing a suture-button system. Repeated measures ANOVA with a Bonferroni/Dunn post-hoc test calculated the interspecimen comparisons. Results: Sectioning of each ligament, beginning with the AITFL, significantly increased talar external rotation. After releasing the AITFL and IOL, fibular external rotation increased significantly. Posterior displacement of the fibula began following the release of AITFL. Significant radiographic widening of the medial clear space and the syndesmosis occurred only after the release of the deltoid ligament. Syndesmotic and medial clear space widening was not significantly different from the intact state under lateral translation until after the release of the deltoid ligament. Placement of the suture-button system successfully reduced the medial clear space but was unable to restore the native stability of the ankle joint. Conclusion: This project addresses rotational and kinematic changes in the ankle after syndesmotic injury by quantifying the effect of ligamentous disruption on the tibiotalar articulation. The change in joint kinematics may explain why patients with moderate-to-severe syndesmosis injuries take longer to heal and develop long-term dysfunction. Significant talar rotation and posterior fibular displacement occur during external rotation, even with moderate syndesmosis injury, and before the disruption of the deltoid ligament. Stress radiography does not appear to be a reliable indicator of mild or moderate syndesmosis injuries.