Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model
Abstract Background Malreduction of unstable syndesmotic ankle fractures is common. This study compared the reduction quality of an anterolateral open technique (OT) versus a conventional minimally invasive technique (MIT). Methods Fourteen fresh-frozen lower torso specimens with 28 matched lower ex...
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| Format: | Article |
| Language: | English |
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BMC
2017-10-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-017-0658-0 |
| _version_ | 1798004024980537344 |
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| author | Adam C. Shaner Norachart Sirisreetreerux Babar Shafiq Lynne C. Jones Erik A. Hasenboehler |
| author_facet | Adam C. Shaner Norachart Sirisreetreerux Babar Shafiq Lynne C. Jones Erik A. Hasenboehler |
| author_sort | Adam C. Shaner |
| collection | DOAJ |
| description | Abstract Background Malreduction of unstable syndesmotic ankle fractures is common. This study compared the reduction quality of an anterolateral open technique (OT) versus a conventional minimally invasive technique (MIT). Methods Fourteen fresh-frozen lower torso specimens with 28 matched lower extremities underwent computed tomography (CT) to measure syndesmosis position before dissection. Reduction was performed using direct visualization and fluoroscopy for the OT group (right-sided specimens) and fluoroscopy only for the MIT group (left-sided specimens). Fixation was achieved with 2 cortical screws. Measurements were repeated with postfixation CT scans. Statistical analysis used a two-tailed t test (α = 0.05). Results Mean posterior fibula-tibia distance decreased after OT by 0.3 ± 0.5 mm and increased after MIT by 0.7 ± 0.6 mm (P = 0.025 for difference between techniques). Mean anterior fibula-tibia distance decreased after OT by 0.4 ± 0.2 mm (P = 0.007) and did not change significantly after MIT (− 0.01 ± 0.4 mm (P = 0.686). Mean anterior translation after OT was 0.04 ± 0.4 mm (P = 0.856), and mean posterior translation after MIT was 0.3 ± 0.7 mm (P = 0.434). Mean medialization after OT was 0.3 ± 0.4 mm (P = 0.132), and mean lateralization after MIT was 0.2 ± 0.6 mm (P = 0.446). Conclusions Both techniques produced near-anatomic reduction of the fibula, with MIT producing significantly more internal rotation malreduction than OT. OT appears to restore near-anatomic fibula position, although this did not differ significantly from the results of MIT. We conditionally recommend OT when closed reduction of the syndesmosis cannot be obtained. |
| first_indexed | 2024-04-11T12:18:09Z |
| format | Article |
| id | doaj.art-4a69bf79969245b2b49c1b61aeff6e30 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T12:18:09Z |
| publishDate | 2017-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-4a69bf79969245b2b49c1b61aeff6e302022-12-22T04:24:12ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2017-10-011211810.1186/s13018-017-0658-0Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver modelAdam C. Shaner0Norachart Sirisreetreerux1Babar Shafiq2Lynne C. Jones3Erik A. Hasenboehler4Department of Orthopaedic Surgery, The Johns Hopkins UniversityDepartment of Orthopaedic Surgery, The Johns Hopkins UniversityDepartment of Orthopaedic Surgery, The Johns Hopkins UniversityDepartment of Orthopaedic Surgery, The Johns Hopkins UniversityDepartment of Orthopaedic Surgery, The Johns Hopkins UniversityAbstract Background Malreduction of unstable syndesmotic ankle fractures is common. This study compared the reduction quality of an anterolateral open technique (OT) versus a conventional minimally invasive technique (MIT). Methods Fourteen fresh-frozen lower torso specimens with 28 matched lower extremities underwent computed tomography (CT) to measure syndesmosis position before dissection. Reduction was performed using direct visualization and fluoroscopy for the OT group (right-sided specimens) and fluoroscopy only for the MIT group (left-sided specimens). Fixation was achieved with 2 cortical screws. Measurements were repeated with postfixation CT scans. Statistical analysis used a two-tailed t test (α = 0.05). Results Mean posterior fibula-tibia distance decreased after OT by 0.3 ± 0.5 mm and increased after MIT by 0.7 ± 0.6 mm (P = 0.025 for difference between techniques). Mean anterior fibula-tibia distance decreased after OT by 0.4 ± 0.2 mm (P = 0.007) and did not change significantly after MIT (− 0.01 ± 0.4 mm (P = 0.686). Mean anterior translation after OT was 0.04 ± 0.4 mm (P = 0.856), and mean posterior translation after MIT was 0.3 ± 0.7 mm (P = 0.434). Mean medialization after OT was 0.3 ± 0.4 mm (P = 0.132), and mean lateralization after MIT was 0.2 ± 0.6 mm (P = 0.446). Conclusions Both techniques produced near-anatomic reduction of the fibula, with MIT producing significantly more internal rotation malreduction than OT. OT appears to restore near-anatomic fibula position, although this did not differ significantly from the results of MIT. We conditionally recommend OT when closed reduction of the syndesmosis cannot be obtained.http://link.springer.com/article/10.1186/s13018-017-0658-0AnkleFibulaMinimally invasive techniqueOpen techniqueSyndesmotic injury |
| spellingShingle | Adam C. Shaner Norachart Sirisreetreerux Babar Shafiq Lynne C. Jones Erik A. Hasenboehler Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model Journal of Orthopaedic Surgery and Research Ankle Fibula Minimally invasive technique Open technique Syndesmotic injury |
| title | Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model |
| title_full | Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model |
| title_fullStr | Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model |
| title_full_unstemmed | Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model |
| title_short | Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model |
| title_sort | open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model |
| topic | Ankle Fibula Minimally invasive technique Open technique Syndesmotic injury |
| url | http://link.springer.com/article/10.1186/s13018-017-0658-0 |
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