Syndesmosis reduction by computer-assisted orthopaedic surgery with navigation: Feasibility and accuracy in a cadaveric study.
BACKGROUND
Syndesmotic disruption may be difficult to reduce and fix, and malreduction is associated with inferior outcomes. Intraoperative computed tomography (CT) can provide accurate assessment of syndesmotic reduction. We hypothesized that three-dimensional (3-D) computer-assisted orthopaedic surgery (CAOS) with navigation of syndesmotic reduction could avoid malreduction. Our goal was to assess feasibility and accuracy of such a technic in a cadaveric study.


METHODS
Eleven through-the-knee cadaveric specimens were used. Ankle CT as control was obtained prior to intervention. The syndesmosis was destabilized by sectioning the tibiofibular ligaments, producing a malreduction temporarily fixed with a Kirschner wire (K-wire). With reference base fixed to the tibia an acquisition scan was made. A K-wire was fixed to the fibula. The K-wire holding the syndesmosis malreduced was removed. The fibula was reduced within the syndesmosis under 3-D CAOS using a navigated K-wire. Once optimal position was obtained by referencing control images, the syndesmosis was fixed with a 3.5mm screw. A CT scan was performed to assess quality of reduction.


RESULTS
Position of the fibula in control and post-reduction CT scans showed a mean anterior-posterior displacement of 0.74 (±0.62)mm. The medial-lateral position measured a mean displacement of 0.68 (±0.76)mm. Rotation of the fibula revealed a mean difference of 0.99° (± 0.73).


CONCLUSIONS
In this cadaveric study, CAOS with navigation allowed for very accurate syndesmosis reduction. This appears to be a promising technique to be confirmed by clinical study.
Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland. Electronic address: victor.dubois-ferriere@hcuge.ch.
Victor
V
Dubois-Ferrière
Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Axel
A
Gamulin
Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland.
Ashwin
A
Chowdhary
Division of Anatomy, University of Geneva Medical Center, Geneva, Switzerland.
Jean
J
Fasel
Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland.
Richard
R
Stern
Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland; Faculté de Médecine, University of Geneva Medical Center, Geneva, Switzerland.
Mathieu
M
Assal
D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D005360:Fibula; D005593:Fracture Fixation, Internal; D006801:Humans; D021621:Imaging, Three-Dimensional; D007593:Joint Instability; D008297:Male; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted; D013977:Tibia; D014057:Tomography, X-Ray Computed
Cadaver; Computer-assisted; Navigation; Reduction; Syndesmosis