Garcini-Munguía F, García-García R, Navarro-Martínez E, Zapien-Aguila S, Rojas-Avilés J

Language: Spanish
References: 13
Page: 82-87
PDF size: 197.99 Kb.

ABSTRACT

Introduction: ligamentous injuries of the distal tibiofibular syndesmosis resulting in its opening are common occurrences in traumatology; however, their diagnosis poses a challenge for orthopedic surgeons. The tibioastragaloid mortise radiograph view is the most commonly used method for diagnosing this type of injury, but its reliability is compromised due to variations in ankle positioning during the study, which often depend on the operator. Objective: to demonstrate that the designed device achieves a correct and consistent radiographic image of the distal tibiofibular syndesmosis in the mortise view. Material and methods: we present a prospective, longitudinal, observational study. We designed a polypropylene device that maintains the ankle at 90 degrees of dorsiflexion and 15 degrees of internal rotation. The device was used to take mortise view radiographs of healthy ankles, and corresponding measurements were taken to assess the syndesmosis. Results: we evaluated a total of 46 radiographs of healthy ankles, with a predominance of left ankles. The obtained measurements were as follows: anterior tibiofibular distance (ATFD) ranged from 3 to 6 mm, posterior tibiofibular distance (PTFD) ranged from 1 to 3 mm, tibiofibular clear space (TFCS) ranged from 2 to 3 mm, and a Merle D'Aubigne ratio of 2:1 was observed in all ankles. When comparing the measurements obtained with those established by Harper and Keller, no statistically significant difference was found (χ² < 5). Conclusion: with the use of the designed device, we achieved a correct and consistent radiographic image of the mortise and the distal tibiofibular syndesmosis.

REFERENCES

1. Van Heest TJ, Lafferty PM. Injuries to the ankle syndesmosis. J Bone Joint Surg Am. 2014; 96(7): 603-13.

2. Doyle MD, Ligas CJ, Vora NS. Acute syndesmosis injuries. Clin Podiatr Med Surg. 2023; 40(1): 23-27.

3. Brosky T, Nyland J, Nitz A, Caborn DN. The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation. J Orthop Sports Phys Ther. 1995; 21(4): 197-205.

4. Vopat ML, Vopat BG, Lubberts B, DiGiovanni CW. Current trends in the diagnosis and management of syndesmotic injury. Curr Rev Musculoskelet Med. 2017; 10(1): 94-103.

5. Yuen CP, Lui TH. Distal tibiofibular syndesmosis: anatomy, biomechanics, injury and management. Open Orthop J. 2017; 11: 670-677.

6. Norkus SA, Floyd RT. The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train. 2001; 36(1): 68-73.

7. Paredes-Vázquez R, Sesma-Villalpando RA, Herrera-Tenorio G, Romero-Ogawa T. Evaluación por tomografía computarizada de diastasis de la sindesmosis en fracturas de tobillo tipo B y C de AO/OTA. Acta Ortop Mex. 2011; 25(1): 32-8.

8. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014; 44(1): 123-40.

9. Nussbaum ED, Hosea TM, Sieler SD, Incremona BR, Kessler DE. Prospective evaluation of syndesmotic ankle sprains without diastasis. Am J Sports Med. 2001; 29(1): 31-5.

10. Brage ME, Rockett M, Vraney R, Anderson R, Toledano A. Ankle fracture classification: a comparison of reliability of three X-ray views versus two. Foot Ankle Int. 1998; 19(8): 555-62.

11. Harper MC, Keller TS. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle. 1989; 10(3): 156-60.

12. Sung KH, Kwon SS, Moon SJ, Lee SY. Radiographic evaluation of the normal ankle joint in children and adolescent. J Orthop Sci. 2018; 23(4): 658-664.

13. Beumer A, Swierstra BA. The influence of ankle positioning on the radiography of the distal tibial tubercles. Surg Radiol Anat. 2003; 25(5-6): 446-50.

EVIDENCE LEVEL

II