INTRODUCTIONDistal tibiofibular syndesmosis injuries are usually associated with ankle fractures, especially common in Denis B and C fractures. Syndesmosis is essential for stability of the ankle mortise that is requi...INTRODUCTIONDistal tibiofibular syndesmosis injuries are usually associated with ankle fractures, especially common in Denis B and C fractures. Syndesmosis is essential for stability of the ankle mortise that is required for weight transmission and walking. The syndesmosis consists of the anteroinferior tibiofibular ligament, posteroinferior tibiofibular ligament, inferior transverse tibiofibular ligament, and interosseous membrane. Internal fixations of the syndesmosis were recommended by most authors to repair the associated ruptured ligaments, which bring about the adverse consequences of limiting the physiological micromovement of the tibiofibular joint to some extent.展开更多
BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupt...BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupture of the interosseous membrane(IOM)is more unstable and severe.The relationship between this type of injury and Maisonneuve injury,in which the syndesmosis is also injured,has not been discussed in the literature previously.CASE SUMMARY A 16-year-old patient sustained left medial malleolar fracture,and the associated inferior tibiofibular syndesmotic instability was overlooked.After open reduction and internal fixation of the medial malleolar fracture,inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging.Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws.Twelve weeks later,the screws were removed.At the 6-mo follow-up,the patient gained full range of motion of the ankle.CONCLUSION Complete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury.Open reduction and internal fixation could obtain good outcomes.展开更多
Reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. Thus, there still remain considerable controversies regarding diagnosis, classification and trea...Reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. Thus, there still remain considerable controversies regarding diagnosis, classification and treatment of syndesmotic injuries. Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery, and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%. Outcome of ankle fractures with syndesmosis injury is worse than without, even after surgical syndesmotic stabilization. This may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls. Therefore, even open visualization of the syndesmosis during the reduction maneuver has been recommended. Thus, the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis. In this context the Tight Rope~?system is reported to have advantages compared to classical syndesmotic screws. However, rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 Tight Ropes~?. Therefore, we developed a new syndesmotic Internal Brace^(TM) technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments. The Internal Brace^(TM) technique was developed by Gordon Mackay from Scotland in 2012 using Swive Locks~? for knotless aperture fixation of a Fiber Tape~? at the anatomic footprints of the augmented ligaments, and augmentation of the anterior talofibular ligament, the deltoid ligament, the spring ligament and the medial collateral ligaments of the knee have been published so far. According to the individual injury pattern,patients can either be treated by the new syndesmotic Internal Brace^(TM) technique alone as a single anterior stabilization, or in combination with one posteriorly directed Tight Rope~? as a double stabilization, or in combination with one Tight Rope~? and a posterolateral malleolar screw fixation as a triple stabilization. Moreover,the syndesmotic Internal Brace^(TM) technique is suitable for anatomic refixation of displaced bony avulsion fragments too small for screw fixation and for indirect reduction of small posterolateral tibial avulsion fragments by anatomic reduction of the anterior syndesmosis with an Internal Brace^(TM) after osteosynthesis of the distal fibula. In this paper, comprehensively illustrated clinical examples show that anatomic reconstruction with rotational stabilization of the syndesmosis can be realized by use of our new syndesmotic Internal Brace^(TM) technique. A clinical trial for evaluation of the functional outcomes has been started at our hospital.展开更多
文摘INTRODUCTIONDistal tibiofibular syndesmosis injuries are usually associated with ankle fractures, especially common in Denis B and C fractures. Syndesmosis is essential for stability of the ankle mortise that is required for weight transmission and walking. The syndesmosis consists of the anteroinferior tibiofibular ligament, posteroinferior tibiofibular ligament, inferior transverse tibiofibular ligament, and interosseous membrane. Internal fixations of the syndesmosis were recommended by most authors to repair the associated ruptured ligaments, which bring about the adverse consequences of limiting the physiological micromovement of the tibiofibular joint to some extent.
文摘BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupture of the interosseous membrane(IOM)is more unstable and severe.The relationship between this type of injury and Maisonneuve injury,in which the syndesmosis is also injured,has not been discussed in the literature previously.CASE SUMMARY A 16-year-old patient sustained left medial malleolar fracture,and the associated inferior tibiofibular syndesmotic instability was overlooked.After open reduction and internal fixation of the medial malleolar fracture,inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging.Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws.Twelve weeks later,the screws were removed.At the 6-mo follow-up,the patient gained full range of motion of the ankle.CONCLUSION Complete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury.Open reduction and internal fixation could obtain good outcomes.
文摘Reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. Thus, there still remain considerable controversies regarding diagnosis, classification and treatment of syndesmotic injuries. Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery, and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%. Outcome of ankle fractures with syndesmosis injury is worse than without, even after surgical syndesmotic stabilization. This may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls. Therefore, even open visualization of the syndesmosis during the reduction maneuver has been recommended. Thus, the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis. In this context the Tight Rope~?system is reported to have advantages compared to classical syndesmotic screws. However, rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 Tight Ropes~?. Therefore, we developed a new syndesmotic Internal Brace^(TM) technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments. The Internal Brace^(TM) technique was developed by Gordon Mackay from Scotland in 2012 using Swive Locks~? for knotless aperture fixation of a Fiber Tape~? at the anatomic footprints of the augmented ligaments, and augmentation of the anterior talofibular ligament, the deltoid ligament, the spring ligament and the medial collateral ligaments of the knee have been published so far. According to the individual injury pattern,patients can either be treated by the new syndesmotic Internal Brace^(TM) technique alone as a single anterior stabilization, or in combination with one posteriorly directed Tight Rope~? as a double stabilization, or in combination with one Tight Rope~? and a posterolateral malleolar screw fixation as a triple stabilization. Moreover,the syndesmotic Internal Brace^(TM) technique is suitable for anatomic refixation of displaced bony avulsion fragments too small for screw fixation and for indirect reduction of small posterolateral tibial avulsion fragments by anatomic reduction of the anterior syndesmosis with an Internal Brace^(TM) after osteosynthesis of the distal fibula. In this paper, comprehensively illustrated clinical examples show that anatomic reconstruction with rotational stabilization of the syndesmosis can be realized by use of our new syndesmotic Internal Brace^(TM) technique. A clinical trial for evaluation of the functional outcomes has been started at our hospital.
