title: Forceps reduction of the syndesmosis in rotational ankle fractures: a cadaveric study.
abstract: BACKGROUND
  Recent studies have shown that it is difficult to accurately reduce and assess the reduction of the syndesmosis after ankle injury. The syndesmosis is most commonly reduced with use of reduction clamps to compress across the tibia and fibula. However, intraoperative techniques to optimize forceps reductions to restore syndesmotic relationships accurately have not been systematically studied. The purpose of the present study was to evaluate the accuracy of syndesmosis reduction with different rotational vectors of clamp placement.
  
  
  METHODS
  Ten through-the-knee cadaveric specimens were used. Markers were placed on the tibia and fibula to produce consistent clamp placement and radiographic evaluation. A computed tomographic scan of the ankle was made to serve as a control, followed by a stepwise destabilization of the anterior inferior tibiofibular ligament, syndesmosis, deltoid ligament, small posterior malleolus fracture, and large posterior malleolus fracture. Following each step in the destabilization, clamps were applied to compress the syndesmosis at varying angles and computed tomography was performed to measure the alignment of the syndesmosis as compared with that on the control scan.
  
  
  RESULTS
  In all degrees of induced instability, and for all vectors of clamp placement, a small but consistent amount of overcompression of the syndesmosis was observed. The average overcompression (and standard deviation) for all samples was 0.93 ± 0.70 mm. Both obliquely oriented clamp arrangements consistently caused fibular malreductions in the sagittal plane. Placing the clamp in the neutral anatomical axis reduced the syndesmosis most accurately, with an average displacement of 0.1 ± 0.77 mm compared with control through all degrees of instability.
  
  
  CONCLUSIONS
  Clamp placement in the neutral anatomical axis reduced the syndesmosis most accurately in our cadaveric model, although slight overcompression was frequently observed. Placing the clamp obliquely malreduced the unstable syndesmosis.
authors: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA. phinit-phisitkul@uiowa.edu
authors: Phinit
authors: P
authors: Phisitkul
authors: Thomas
authors: T
authors: Ebinger
authors: Jessica
authors: J
authors: Goetz
authors: Tanawat
authors: T
authors: Vaseenon
authors: J Lawrence
authors: JL
authors: Marsh
mesh_terms: D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D002102:Cadaver; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D015203:Reproducibility of Results; D012399:Rotation; D013525:Surgical Instruments; D013977:Tibia / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed