title: The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up.
abstract: OBJECTIVE
  To examine the correlation between syndesmotic malreduction and functional outcome.
  
  
  METHODS
  Prospective evaluation of bilateral computed tomography scans and functional outcome scores.
  
  
  METHODS
  Level I regional trauma center.
  
  
  METHODS
  From January 1, 2004, to December 31, 2006, 107 of 681 operatively treated ankle fractures (15.7%) had associated syndesmotic injuries requiring reduction and fixation. All patients available at a minimum of 2 years postindex procedure underwent clinical and radiographic examination, computed tomographic (CT) scanning of both ankles (injured and uninjured), and functional outcome scoring using the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires.
  
  
  RESULTS
  Sixty-eight of 107 (63.5%) syndesmotic injuries in 68 patients were available for follow-up. Twenty-seven (39%) were malreduced (rotational or translational asymmetry) when compared with the contralateral uninjured syndesmotic joint. Fifteen percent of the open syndesmotic reductions were malreduced on postoperative CT scans, whereas 44% (A/B) of the closed syndesmotic reductions were malreduced on postoperative CT scan (P = 0.11). Patients with a malreduced syndesmosis recorded significantly worse functional outcome scores (P < 0.05) on both the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires when compared with those patients whose syndesmosis had healed in anatomic alignment.
  
  
  CONCLUSIONS
  At a minimum of 2 years follow-up, patients with malreduced syndesmotic injuries demonstrated significantly worse functional outcome using the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires. Open reduction of the syndesmosis resulted in a substantially lower rate of malreduction when evaluated by postoperative CT scan. Based on these findings, we recommend that surgeons not only perform a direct, open visualization of the syndesmosis during the reduction maneuver, but obtain a postoperative CT scan with comparison to the contralateral extremity as well. If the syndesmosis is found to be malreduced, consideration must be given to revising the osteosynthesis.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Orthopaedic Trauma Service, Tampa General Hospital, University of South Florida, Tampa, FL 33606, USA. eversosaggy@me.com
authors.forename: H Claude
authors.initials: HC
authors.lastname: Sagi
authors.forename: Anjan R
authors.initials: AR
authors.lastname: Shah
authors.forename: Roy W
authors.initials: RW
authors.lastname: Sanders
mesh_terms: D016512:Ankle Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017760:Bone Malalignment; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations; D007593:Joint Instability; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000379:methods