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Intraoperative Syndesmotic Reduction
- Source :
- The Journal of Bone & Joint Surgery. 95:1838-1843
- Publication Year :
- 2013
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2013.
-
Abstract
- Background: The quality of reduction of the syndesmosis is an important factor in the outcome of ankle fractures associated with a syndesmotic injury. The purpose of this study was to directly compare the accuracy of syndesmotic reductions obtained using intraoperative standard fluoroscopic techniques against reductions obtained using three-dimensional imaging of the Iso-C3D fluoroscope. Methods: We prospectively reviewed imaging studies of patients who were diagnosed as having preoperative or intraoperative evidence of syndesmotic diastasis (on the basis of the fluoroscopic Cotton test and/or a manual external rotation stress test) who underwent syndesmotic fixation at one of two level-I trauma centers. Center A used intraoperative computed tomography (CT) imaging to assess reduction (≤2 mm), while Center B assessed reduction under standard fluoroscopic imaging. Postoperative alignment was assessed in a standardized manner, measuring anterior fibular distance, posterior fibular distance, and the anterior translation distance. Measurements were taken on the injured side and the uninjured side and compared between the groups on postoperative axial CT scans. Results: A total of thirty-six patients in both centers met our inclusion criteria and were included in the data analysis. Despite utilization of the Iso-C3D, a high rate of malreductions was noted in both groups. Anterior translation distance malreductions occurred in 31% of the sixteen patients in Center A and 25% of the twenty patients in Center B (p = 0.72). The number of anterior fibular distance malreductions was similar, with a rate of 38% in Center A and 30% in Center B (p = 0.73). A significant difference among the centers (p = 0.03) was noted, however, when the posterior fibular distance data was analyzed, with 6% being malreduced by >2 mm in Center A and 40% in Center B. Conclusions: The results of our study support previous investigations that have cited high rates of syndesmotic malreductions and demonstrate that the addition of advanced intraoperative imaging techniques does not help to reduce the rate of malreductions in this cohort. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
- Subjects :
- Adult
Male
Syndesmosis
medicine.medical_specialty
Ankle Fractures
Fracture Fixation, Internal
Imaging, Three-Dimensional
Fracture fixation
medicine
Humans
Fluoroscopy
Orthopedics and Sports Medicine
Ankle Injuries
Prospective Studies
Prospective cohort study
Fixation (histology)
Intraoperative Care
medicine.diagnostic_test
business.industry
General Medicine
Middle Aged
medicine.disease
Surgery
Treatment Outcome
medicine.anatomical_structure
Orthopedic surgery
Diastasis
Manipulation, Orthopedic
Female
Ankle
Tomography, X-Ray Computed
Nuclear medicine
business
Subjects
Details
- ISSN :
- 00219355
- Volume :
- 95
- Database :
- OpenAIRE
- Journal :
- The Journal of Bone & Joint Surgery
- Accession number :
- edsair.doi.dedup.....24127e11a6f6154a14ef494a50254b5e
- Full Text :
- https://doi.org/10.2106/jbjs.l.00382