Comparison of radiologic and arthroscopic diagnoses of distal tibiofibular syndesmosis disruption in acute ankle fracture.
OBJECTIVE
The purpose of this study was to compare intraoperative stress radiography and ankle arthroscopy in the evaluation of distal tibiofibular syndesmosis disruption in acute ankle fracture.


METHODS
Prospective study.


METHODS
We treated 53 Weber type B or C ankle fractures without radiographic evidence of frank syndesmosis diastasis. Intraoperative stress radiography and ankle arthroscopy were performed. Syndesmotic screws were inserted in those patients with syndesmosis diastasis. Screws were removed 12 weeks later and second-look ankle arthroscopy was performed at the same time.


RESULTS
Sixteen cases (30.2%) had positive intraoperative stress radiographs; 35 cases (66.0%) had positive arthroscopic findings of syndesmosis diastasis, including various combinations of coronal, sagittal, and rotational planes of instability. During second-look arthroscopy, 31 of 34 patients with syndesmotic screws showed healing of the syndesmotic ligaments and the syndesmosis became stable.


CONCLUSIONS
Ankle arthroscopy excels intraoperative stress radiography in detecting syndesmosis disruption. It also provides assessment of different planes of instability and assists anatomic reduction of the syndesmosis. Intraoperative radiography still does play an important role in assessing fracture reduction and proper restoration of fibular length and longitudinal orientation of the syndesmosis.


METHODS
Level 2.
Lui
Tun Hing
TH
Department of Orthopaedics and Traumatology, North District Hospital, NT, Hong Kong SAR, China. luithderek@yahoo.co.uk
Ip
KaiYuen
K
Chow
Hung Tsan
HT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D001182:Arthroscopy; D001863:Bone Screws; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005592:Fracture Fixation; D017102:Fracture Healing; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D018460:Fractures, Comminuted / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D008023:Ligaments, Articular / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D015641:Radiography, Interventional; D012421:Rupture / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D024162:Second-Look Surgery