Journal
JOURNAL OF ORTHOPAEDIC TRAUMA
Volume 36, Issue 12, Pages 658-664Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BOT.0000000000002443
Keywords
syndesmosis; tibia plafond; tibia pilon; articular fracture; post-traumatic osteoarthritis
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This study evaluated the reliability of measurement techniques for syndesmosis position after operative fixation of distal tibia plafond fracture using weight-bearing computed tomography (WBCT). The study found that syndesmosis malposition is common after these injuries and is associated with impaired physical function.
Objectives:To evaluate reliability of measurement techniques for syndesmosis position after operative fixation of distal tibia plafond fracture on weight-bearing computed tomography (WBCT), identify risk factors for syndesmosis malposition, and determine if syndesmosis malposition is associated with higher pain and lower physical function.Design:Prospective cohort study.Setting:Three Level 1 trauma centers.Participants:Twenty-six subjects who underwent open reduction and internal fixation of distal tibia plafond fractures with bilateral ankle WBCT 1 year or greater after injury were included in the study.Intervention:Operative fixation of distal tibia plafond fracture.Main Outcome Measurement:Fibula position in the tibia incisura, injury characteristics, and patient-reported outcomes were the main outcome measurements.Results:Interrater reliability for syndesmosis position measurements were excellent for the Phisitkul technique on both injured and healthy ankles (intraclass correlation coefficients [ICCs]: 0.93-0.98). The Nault technique demonstrated moderate-to-excellent interrater reliability (ICCs: 0.67-0.98), apart from the angle of rotation measurement (ICCs: 0.18-0.67). Sixteen of 26 subjects (62%) had syndesmosis malposition defined as >2 mm difference comparing the tibial-fibular relationship in injured and uninjured ankles using these 2 methods. Patients with syndesmosis malposition reported lower Foot and Ankle Ability Measure: Activities of Daily Living scores; other recorded patient-reported outcomes were not significantly different.Conclusions:Measurement techniques for syndesmosis position on WBCT were reliable after operative fixation of distal tibia plafond fracture. Syndesmosis malposition is common after these injuries and predicted impaired physical function.
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