The distal tibiofibular syndesmosis during passive foot flexion. RSA-based study on intact, ligament injured and screw fixed cadaver specimens.
BACKGROUND
The aim of the study was to investigate the kinematics of the distal tibiofibular syndesmosis in intact and ligament injured ankles and to assess how effective is the syndesmotic screw in restraining mortise width variations during passive foot flexion.


METHODS
The trials were carried out on seven fresh frozen cadaver specimens. The distal tibiofibular syndesmosis widening was investigated using Roentgen stereophotogrammetric analysis, in intact and ligament injured ankles and after the fixation of the syndesmotic screw. The AO-ASIF recommendations were followed for screw implant.


RESULTS
Injury to the syndesmotic and deltoid ligaments of the ankle did not result in a significant variation of the syndesmosis behavior during passive foot flexion. The 4.5-mm diameter cortical screw used in this study proved effective in restraining mortise width variation during foot flexion. The recorded mortise widening in the flexion arc extending from the neutral to the maximally dorsiflexed position was negligible in intact and ligament injured joints.


CONCLUSIONS
The result does not endorse the recommendation of placing the foot in full dorsal flexion during screw implantation. The choice of screw fixation as a treatment for ankle syndesmosis disruption should be carefully evaluated.
Biomechanics Laboratory, Centro di Ricerca Codivilla-Putti, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy. l.bragonzoni@biomec.ior.it
Laura
L
Bragonzoni
Alessandro
A
Russo
Mauro
M
Girolami
Ugo
U
Albisinni
Andrea
A
Visani
Nicoletta
N
Mazzotti
Maurilio
M
Marcacci
D016512:Ankle Injuries / Q000601:surgery; D000843:Ankle Joint / Q000601:surgery*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007103:Immobilization; D017844:Lateral Ligament, Ankle / Q000293:injuries / Q000601:surgery*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010780:Photogrammetry; D016059:Range of Motion, Articular