Comparison of Two Intraoperative Assessment Methods for Injuries to the Ankle Syndesmosis: A Cadaveric Study

Stoffel, Karl; Wysocki, David; Baddour, Edward; Nicholls, Rochelle; Yates, Piers
November 2009
Journal of Bone & Joint Surgery, American Volume;Nov2009, Vol. 91-A Issue 11, p2646
Academic Journal
Background: lntraoperative stress testing is required for the detection of syndesmosis instability following an ankle fracture. The present study compared two stress tests for the detection of syndesmotic injury. Methods: A true mortise radiograph of the ankle was made for fourteen cadaver joints. Specimens were randomized into two groups to simulate ligament and syndesmosis injury on the basis of the Danis-Weber classification system. In the first group, the anterior inferior tibiofibular ligament was divided first (Weber Br), followed sequentially by division of the interosseous membrane (Weber C) and the deltoid ligament. In the second group, the deltoid ligament was divided first, followed by the anterior inferior tibiofibular ligament. Radiographs were made at each stage with use of two methods of stressing the ankle mortise: (1) external rotation of the foot with an external moment of 7.5 Nm, and (2) application of a lateral force of 100 N. Tibiofibular overlap, tibiofibular clear space, and medial clear space were measured. Results: Lateral stress produced a significantly greater increase in the tibiofibular clear space than did the external rotation test for Weber C injuries and Weber C plus deltoid ligament injuries. A greater increase in the tibiofibular clear space was noted during the lateral stress test when both the deltoid and the anterior inferior tibiofibular ligament had been sectioned (p < 0.05). The external rotation stress test produced a significant increase in the medial clear space in the presence of isolated anterior inferior tibiofibular ligament and deltoid ligament injuries (p <0.05). Conclusions: For the detection of syndesmotic instability at the site of ankle fractures on stress radiographs, the lateral stress test appeared to be superior to the external rotation stress test in this cadaver model. Clinical Relevance: The present study gives insight into the types of ligament damage that will produce a positive result on stress radiographs with use of two common intraoperative stress tests. Establishment of clinical correlation with the results of this cadaver model is necessary in order to develop operative guidelines.


Related Articles

  • Risk Factors for Fractures of the Wrist, Shoulder and Ankle: The Blue Mountains Eye Study. Ivers, R. Q.; Cumming, R. G.; Mitchell, P.; Peduto, A. J. // Osteoporosis International;Jun2002, Vol. 13 Issue 6, p513 

    : Few studies have examined risk factors for fractures of the wrist, shoulder or ankle. The Blue Mountains Eye Study is a population-based longitudinal study in 3654 people aged 49 years or older resident in an area west of Sydney, Australia. Detailed eye examinations and interviews were carried...

  • MANAGING PERIOPERATIVE RISK. Sharvill, Rory J. // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;10/29/2011, Vol. 343 Issue 7829, p861 

    A letter to the editor is presented in response to the article "Managing Perioperative Risk in Patients Undergoing Elective Noncardiac Surgery," by R. M. Pearse and colleagues in the October 5, 2011 issue.

  • Quantification of bone strength by intraoperative torque measurement: a technical note. Suhm, Norbert; Haenni, Markus; Schwyn, Ronald; Hirschmann, Michael; Müller, Andreas Marc // Archives of Orthopaedic & Trauma Surgery;Jun2008, Vol. 128 Issue 6, p613 

    Bone strength describes the resistance of bone against mechanical failure. Bone strength depends on both the amount of bone and the bone’s quality, and the bone strength may be looked upon as a relevant parameter to judge an osteosynthesis’ stability. Information about bone...

  • The mehta lower limb elevator. Chatterij, S.; Sultan, J.; Finlayson, G.; Mehta, J. // Muscles, Ligaments & Tendons Journal (MLTJ);2012 Supplement, p37 

    Background: foot and ankle surgery often requires the use of intra-operative radiography. To ascertain three-dimensional positions of screws and bony fragments, multiple views are needed, with at least two orthogonal views - usually anteroposterior (AP) and lateral. AP views are achievable...

  • Commonly Asked Foot and Ankle Coding Que. LeGrand, Mary // AAOS Now;Aug2012, Vol. 6 Issue 8, p28 

    The article presents questions and answers related to ankle and foot coding que including fracture of the metatarsal bones, osteochondritis dissecans surgery and pilon fracture temporizing management.

  • Study suggests basing SE4 ankle fracture treatment on size of medial clear space. Rapp, Susan M. // Orthopedics Today;Apr2011, Vol. 31 Issue 4, p62 

    The article reports on the recommendation of a study that orthopedists should consider the amount of medial clear space and fracture location in deciding whether to cast or perform surgery patients with stress positive supination-external rotation (SE) type 4 ankle fractures.

  • Arthroscopy, absorbable implants, computers to aid ankle fracture care. Rapp, Susan M. // Orthopedics Today;Apr2008, Vol. 28 Issue 4, p72 

    The article reports that technological advancements can be utilized in the future to improve ankle fracture management. According to doctor Shepard R. Hurwitz, arthroscopic techniques, locking plates, bioabsorbable screws and plates and computer assistance will aid orthopedists in managing...

  • The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature. Ahmed, Syed Kamran; Keung Fung, Boris Kwok; Wing Yuk Ip; Fok, Margaret; Shew Ping Chow // Journal of Orthopaedic Surgery & Research;2008, Vol. 3, Special section p1 

    Background: Reverse flow sural neurocutaneous flap has been utilized more frequently during the past decade to cover vital structures around the foot and ankle area. The potential advantages are the relatively constant blood supply, ease of elevation and preservation of major vascular trunks in...

  • The Modular Universal Tumour And Revision System (MUTARS®) in endoprosthetic revision surgery. Gebert, Carsten; Wessling, Martin; Götze, Christian; Gosheger, Georg; Hardes, Jendrik // International Orthopaedics;Dec2010, Vol. 34 Issue 8, p1261 

    The aim of this study was to present the clinical and functional results of revision surgery after failed hip endoprostheses using the Modular Universal Tumour And Revision System (MUTARS®). Functional results of the hip endoprostheses were recorded by applying the Harris hip score. The...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics