title: Syndesmotic Malreduction after Ankle ORIF; Is Radiography Sufficient?
abstract: BACKGROUND
  Ankle fractures, especially those resulting from external rotation mechanisms are associated with injury to the distal tibiofibular syndesmosis. Some authors have recommended performing CT scanning after open ankle surgery to evaluate the reduction of syndesmosis. In this current study, we aimed to investigate the sensitivity of plain radiography in diagnosing syndesmosis malreduction after open reduction and internal fixation (ORIF) in patients with ankle fractures.
  
  
  METHODS
  Thirty patients with ankle fractures participated in this prospective study. ORIFs were performed with respect to all of the technical guidelines shown in orthopedic literature for exact syndesmosis reduction, such as fibular length and proper settings. In the operating room, plain radiography was performed in anteroposterior, mortise and lateral views to assess whether syndesmosis was malreduced. If malreduction was detected, the patient was revised. As the gold standard, patients underwent postoperative bilateral CT scanning to investigate the syndesmosis reduction which was then compared to the healthy side. Finally, the sensitivity of plain radiography in the diagnosis of syndesmosis malreduction was determined by comparing this method to CT scanning.
  
  
  RESULTS
  In both of the methods we did not find any patient with syndesmosis malreduction. Hence, the sensitivity of plain radiography was determined 100%.
  
  
  CONCLUSIONS
  Based on our findings, there is no need to perform CT scanning to evaluate syndesmosis reduction after ankle ORIF in patients with ankle fractures. Plain radiography is sufficient and has satisfactory sensitivity in these patients.
authors.affiliation: Alireza Manafi Rasi MD, Gholamhossein Kazemian MD, Mohamad M Omidian MD, Ali Nemati MD, Department of Orthopedic Surgery Imam Hossein Hospital Shahid Beheshti University of Medical Sciences Tehran, Iran.
authors.forename: Alireza Manafi
authors.initials: AM
authors.lastname: Rasi
authors.affiliation: Alireza Manafi Rasi MD, Gholamhossein Kazemian MD, Mohamad M Omidian MD, Ali Nemati MD, Department of Orthopedic Surgery Imam Hossein Hospital Shahid Beheshti University of Medical Sciences Tehran, Iran.
authors.forename: Gholamhossein
authors.initials: G
authors.lastname: Kazemian
authors.affiliation: Alireza Manafi Rasi MD, Gholamhossein Kazemian MD, Mohamad M Omidian MD, Ali Nemati MD, Department of Orthopedic Surgery Imam Hossein Hospital Shahid Beheshti University of Medical Sciences Tehran, Iran.
authors.forename: Mohamad M
authors.initials: MM
authors.lastname: Omidian
authors.affiliation: Alireza Manafi Rasi MD, Gholamhossein Kazemian MD, Mohamad M Omidian MD, Ali Nemati MD, Department of Orthopedic Surgery Imam Hossein Hospital Shahid Beheshti University of Medical Sciences Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Nemati
keywords: Ankle fracture; CT scanning; Plain radiography; Syndesmosis