Novel flexible suture fixation for the distal tibiofibular syndesmotic joint injury: a cadaveric biomechanical model.
Syndesmotic injuries of the ankle commonly occur by an external rotation force applied to the ankle joint. Ten fresh-frozen lower extremities from cadavers were used. A specially designed apparatus was used to stabilize the specimen and rotate the ankle joint from internally rotated 25° to externally rotated 35° at a rate of 6°/s for 10 cycles. Two stages were tested (stage I, specimens intact; and stage II, simulated pronation external rotation type injury with fixation). Group 1 was fixed with a novel suture construct across the syndesmotic joint, and group 2 was fixed with a single metallic screw. The torque, rotational angle, and 3-dimensional syndesmotic diastasis readings were recorded. Three-dimensional tibiofibular diastasis was identified. The fibula of the intact specimens displaced an average of 8.6 ± 1.7, 2.4 ± 1.0, and 1.4 ± 1.0 mm in the anterior, lateral, and superior direction, respectively, when the foot was externally rotated 35°. The sectioning of the syndesmostic ligaments and deltoid ligament resulted in a significant decrease in syndesmotic diastasis and foot torsional force (p < .05). The ligament-sectioned specimen lost 57% (externally rotated) and 17% (internally rotated) torsional strength compared with the intact specimen. Groups 1 and 2 provided similar biomechanical stability in this cadaveric model of a syndesmosis deficiency.
Submitted while Fifth-Year Resident, Orthopaedics Residency, The University of Kansas School of Medicine-Wichita, Wichita, KS.
Brandon E
BE
Gough
Research Engineer and Teaching Associate, Via Christi Health, Orthopedic Research Institute, Wichita, KS. Electronic address: alexander.chong@viachristi.org.
Alexander C M
AC
Chong
Associate Professor, Department of Orthopaedics Surgery, The University of Kansas School of Medicine-Wichita, Wichita, KS.
Steven J
SJ
Howell
Submitted while Fourth-Year Medical Student, University of Kansas School of Medicine-Wichita, Wichita, KS.
Joseph W
JW
Galvin
Research Director and Professor, Via Christi Health, Orthopedic Research Institute, Wichita, KS.
Paul H
PH
Wooley
D000368:Aged; D016512:Ankle Injuries / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D002102:Cadaver; D005360:Fibula / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D008953:Models, Anatomic; D012399:Rotation; D013536:Suture Techniques; D013977:Tibia / Q000503:physiopathology
cadaver specimen; deltoid ligament; fibula; syndesmosis; tibia; tibiofibular diastasis