title: A reliable method for intraoperative evaluation of syndesmotic reduction.
abstract: OBJECTIVE
  To determine the accuracy of a technique for intraoperative assessment of syndesmotic reduction in ankle fractures.
  
  
  METHODS
  Prospective, case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Eighteen consecutive patients with suspected syndesmotic injuries were enrolled between 2007 and 2009. The diagnosis of syndesmotic injury was based on static ankle radiographs. The study group consisted of 12 male and 6 female patients with an average age of 32 years (range 19-56 years).
  
  
  METHODS
  All patients had mortise and talar dome lateral fluoroscopic images obtained of the uninjured ankle in the operating room. The injured ankle underwent operative reduction and provisional fixation using the uninjured ankle radiographs as a template for comparison. An intraoperative computed tomography (CT) scan was obtained to verify the syndesmotic reduction before syndesmotic fixation. If the reduction was not anatomic, the reduction was revised using fluoroscopy and the CT repeated.
  
  
  METHODS
  Accuracy of syndesmotic reduction performed using fluoroscopy and confirmed by intraoperative CT scan.
  
  
  RESULTS
  Using the technique described, intraoperative CT confirmed anatomic reduction initially in 17 of the 18 fractures. The 1 case where CT did change the course of treatment, revision of fibular fracture reduction resulted in an anatomic reduction of the syndesmosis on repeat CT.
  
  
  CONCLUSIONS
  Accurate evaluation of the syndesmotic reduction can be determined intraoperatively using comparison mortise and talar dome lateral fluoroscopic images. Direct visualization of the syndesmosis or CT may not be necessary to achieve an accurate reduction in these injuries.
authors.affiliation: Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA. hobieds@yahoo.com
authors.forename: Hobie D
authors.initials: HD
authors.lastname: Summers
authors.forename: Micah K
authors.initials: MK
authors.lastname: Sinclair
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stover
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007869:Leg Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D008022:Ligaments / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D055815:Young Adult