Foot & Ankle International - July 2016 - (Page 722)

634791 FAIXXX10.1177/1071100716634791Foot & Ankle InternationalHaynes et al research-article2016 Article Increased Reduction Clamp Force Associated With Syndesmotic Overcompression Foot & Ankle International® 2016, Vol. 37(7) 722-729 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100716634791 fai.sagepub.com Jacob Haynes, MD1, Steven Cherney, MD1, Amanda Spraggs-Hughes, MA1, Christopher M. McAndrew, MD, MSc1, William M. Ricci, MD1, and Michael J. Gardner, MD1 Abstract Background: The distal tibiofibular syndesmosis is disrupted in up to 45% of operatively treated ankle fractures, and syndesmotic malreduction has historically been correlated with poor outcome. The purpose of this study was to quantify the clamp force used during syndesmotic reduction and to evaluate the effect of clamp force on fibular overmedialization (overcompression) at the level of the distal tibiofibular syndesmosis. Methods: A prospectively recruited cohort of 21 patients underwent operative syndesmotic reduction and fixation. A ball point periarticular reduction forceps that was modified to include a load cell in one tine was used for the reduction, and the clamp force required for reduction was measured. Patients underwent postoperative bilateral computed tomographic scans of the ankle and hindfoot to assess syndesmotic reduction. The uninjured extremity was used as a control. Side-toside differences in fibular medialization, translation, and rotation within the tibial incisura were measured. These findings were correlated with the reduction clamp force utilized to obtain the reduction. Results: Syndesmotic overcompression (fibular medialization greater than 1.0 mm when compared with noninjured ankle) was seen in 11 of 21 patients (52%). Increased clamp force significantly correlated with syndesmotic overcompression. The mean reduction clamp forces were 88 N for the undercompressed group, 130 N for the adequately compressed group, and 163 N for the overcompressed group. Conclusion: This study demonstrated a significant correlation between increased clamp forces and syndesmotic overcompression, and determined objective forces that lead to overcompression. Our results indicate that surgeons should be cognizant of the clamp force used for syndesmotic reduction. Level of Evidence: Level III, case-control series, in accordance with STROBE guidelines. Keywords: syndesmosis, ankle fracture, malreduction, overcompression, trauma Introduction The distal tibiofibular syndesmosis is disrupted in 20% to 45% of operatively treated ankle fractures.15,23 Syndesmotic malreduction has historically been one of the strongest predictors of a poor outcome in patients with ankle trauma, and inaccurate reduction has been correlated with earlyonset ankle arthrosis and decreased patient functional scores.4,11,18,20,24,26 A recent study by Warner et al, which found no difference in short-term clinical outcomes between uninjured ankles and those with operatively treated syndesmotic injuries with syndesmotic malreductions within 1.88 mm of displacement and 5.75 degrees of rotation, has challenged this concept.25 Excessive medialization of the fibula within the tibial incisura ("overcompression") after reduction and fixation of syndesmotic injuries is a topic for which there is a paucity of literature. A single case report has illustrated this phenomenon, although recent cadaveric studies have shown that excessive fibular medialization is possible.16,19 Recent data from our institution revealed that 12 of 27 patients (44%) treated with syndesmotic reduction and fixation had excessive medialization of the fibula by greater than 1.0 mm when compared with the contralateral uninjured ankle on postoperative CT scan.5 Overcompression of the 1 Washington University School of Medicine, St. Louis, Missouri, USA Corresponding Author: Michael J. Gardner, MD, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA. Email: michaelgardnermd@gmail.com http://www.sagepub.com/journalsPermissions.nav http://fai.sagepub.com

Table of Contents for the Digital Edition of Foot & Ankle International - July 2016

TOC/TOC/Verso
Editorial Board
Advertiser Index
Long Term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction
Clinical Outcome and Fusion Rate following Simultaneous Subtalar Fusion and Total Ankle Arthoplasty
Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty
Secondary Arthrodesis After Total Ankle Arthroplasty
Functional Outcomes Following First Metatarsophalangeal Arthrodesis
Increased Reduction Clamp Force Associated With Syndesmotic Overcompression
Pain Threshold Tests in Patients With Heel Pain Syndrome
Long-term Results of Chronic Achilles Tendon Ruptures With V-Y Tendon Plasty and Fascia Turndown
Peroneal Tendon Abnormalities on Routine Magnetic Resonance Imaging of the Foot and Ankle
Incisura Morphology as a Risk Factor for Syndesmotic Malreduction
Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux
Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy
Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act
Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia
Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia: A Prospective Study of 78 Cases.
Response to "Letter Regarding: Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia"
The Internal Brace for Midsubstance Achilles Ruptures
The Evolution of Patient Safety
Education Calendar
Foot & Ankle International - July 2016

Foot & Ankle International - July 2016