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Acute syndesmotic injuries in ankle fractures:From diagnosis to treatment and current concepts

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World Journal of Orthopedics 2021年第5期12卷 270-291页

作者： Francesco Pogliacomi Massimo De Filippo Daniele Casalini Alberto Longhi Fabrizio Tacci Rocco Perotta Francesco Pagnini Silvio Tocco Francesco Ceccarelli Department of Medicine and Surgery Orthopaedic ClinicParma 43126Italy Department of Medicine and Surgery University of ParmaParma 43126Italy Centro Riabilitativo della Mano e Arto Superiore Parma 43121Italy

A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship,and it is essential for normal motion of the ankle *** disruption of this joint is frequently accompanied by rotational ankle fracture,such as pronation-external rotation,and rarely occurs without ankle *** diagnosis is not simple,and ideal management of the various presentations of syndesmotic injury remains controversial to this *** restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional *** such an injury,including inadequately treated,misdiagnosed and correctly diagnosed cases,a chronic pattern characterized by persistent ankle pain,function disability and early osteoarthritis can *** paper reviews anatomical and biomechanical characteristics of this syndesmosis,the mechanism of its acute injury associated to fractures,radiological and arthroscopic diagnosis and surgical treatment.

关键词： Ankle Fracture Injury Distal tibiofibular joint Trauma syndesmosis

Ankle Arthroscopy: A Complimentary Adjunct in the Diagnosis and Management of Ankle Fractures

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Open Journal of Orthopedics 2020年第12期10卷 403-411页

作者： Ciaran McDonald Conor O’Dwyer Peter McLoughlin Rebecca Jeanne Bermingham Thomas Bayer Department of Orthopaedics and Trauma Midlands Regional Hospital Tullamore Tullamore Ireland

Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the Lauge-Hansen fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, versus ORIF plus arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/- arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the Lauge-Hansen ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with an SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes.

关键词： Ankle Fracture Arthroscopy Osteochondral Injury syndesmosis Lauge-Hansen ORIF Ligamentous Injury syndesmosis Disruption Persistent Ankle Pain Post-Traumatic Arthritis

Ankle injuries in athletes:A review of the literature

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World Journal of Meta-Analysis 2021年第2期9卷 128-138页

作者： Jenita Jona James Oday Al-Dadah The Medical School Newcastle UniversityNewcastle-upon-Tyne NE24HHUnited Kingdom Translational and Clinical Research Institute Faculty of Medical SciencesNewcastle UniversityNewcastle-upon-Tyne NE24HHUnited Kingdom

Ankle injuries are commonplace in the athletic population, with lateral ligamentsprains accounting for the majority of them. The medial ligament complex, thedistal tibiofibular syndesmosis as well as any of the bones that constitute the anklejoint can also be injured. Typical mechanisms of injury include inversion-plantarflexionand external rotation on a supinated, dorsiflexed or pronated foot. Lesionsof the ankle present with similar symptoms of pain, swelling and ***, a thorough history and physical examination must be obtained to makethe correct diagnosis. This is especially critical for athletes as certain injuries canlead to termination of their career if not treated accurately on time. Imaging maybe useful in some cases to confirm or rule out differential diagnoses. Most injuriescan be managed conservatively using the Protection, Rest, Ice, Compression andElevation protocol followed by a comprehensive rehabilitation *** is reserved for grade III ligament tears that are refractory to initial nonoperativetreatment and displaced fractures that are unlikely to unite withoutsurgical intervention. The objective of this review is to discuss the common ankleinjuries encountered in the athletic population and the approaches to theirdiagnosis and management.

关键词： Ankle sprain Athlete Deltoid ligament Lateral ligament syndesmosis Fracture

Diagnosing syndesmotic instability in ankle fractures

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World Journal of Orthopedics 2011年第7期2卷 51-56页

作者： Michel PJ van den Bekerom Academic Medical Center Department of Orthopaedic SurgeryOrthopaedic Research Center Amsterdam1105 AZ AmsterdamThe Netherlands

The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic *** article summarizes the available evidence in the light of the author’s ***-operative radiographic assessment,standard radiographs,computed tomography scanning and magnetic resonance imaging are of limited value in detecting syndesmotic instability in acute ankle fractures but can be helpful in ***-operative stress testing,in the sagittal,coronal or exorotation direction,is more reliable in the diagnosis of syndesmotic instability of rotational ankle *** Hook or Cotton test is more reliable than the exorotation stress *** lateral view is more reliable than the AP mortise view because of the larger displacement in this *** the Hook test is used the force should be applied in the sagittal direction.A force of 100 N applied to the fibula seems to be *** the case of an unstable joint requiring syndesmotic stabilisation,the tibiofibular clear space would exceed 5 mm on the lateral stress *** the surgeon is able to perform an ankle arthroscopy this technique is useful to detect syndesmotic injury and can guide anatomic reduction of the *** guidelines formulated in this article are based on biomechanical and cadaveric studies and clinical correlation has to be established.

关键词： Ankle fracture syndesmosis Ligament Instability Operative treatment Stabilisation