title: In Vivo Syndesmotic Overcompression After Fixation of Ankle Fractures With a Syndesmotic Injury.
abstract: OBJECTIVE
  The goals of this study were to assess syndesmotic reductions using computerized tomography and to determine whether malreductions are associated with certain injury types or reduction forceps.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Urban level 1 trauma center.
  
  
  METHODS
  Twenty-seven patients with operatively treated syndesmotic injuries were recruited prospectively.
  
  
  METHODS
  Patients underwent postoperative bilateral computerized tomography of the ankle and hindfoot to assess syndesmotic reduction. The uninjured extremity was used as a control.
  
  
  METHODS
  Side-to-side differences of the fibular position within the tibial incisura were measured at several anatomic points and analyzed based on injury type, the presence of posterior malleolar injury, level of fracture, and type of reduction forceps used.
  
  
  RESULTS
  On average, operatively treated syndesmotic injuries were overcompressed (fibular medialization) by 1 mm (P < 0.001) and externally rotated by 5° (P = 0.002) when compared with the uninjured extremity. The absence of a posterior malleolar injury and Weber B (OTA 44-B) fractures seemed to have a protective effect against malrotation, but not against overcompression. There was no difference in malreduction based on the type of the clamp used.
  
  
  CONCLUSIONS
  It is possible, and highly likely based on these data, to overcompress the syndesmosis when using reduction forceps. Care should be taken to avoid overcompression, as this may affect the ankle motion and functional outcomes. To our knowledge, this is the first in vivo series of syndesmotic overcompression.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors: Steven M
authors: SM
authors: Cherney
authors: Jacob A
authors: JA
authors: Haynes
authors: Amanda G
authors: AG
authors: Spraggs-Hughes
authors: Christopher M
authors: CM
authors: McAndrew
authors: William M
authors: WM
authors: Ricci
authors: Michael J
authors: MJ
authors: Gardner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016512:Ankle Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult