treatment of neglected syndesmotic injuries of neglected... · hsu, et al. syndesmotic injuries in...
TRANSCRIPT
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TREATMENT OF NEGLECTED SYNDESMOTIC INJURIESStephen Schmid DPM
Chief of Surgery, Lake Region Hospital
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CONFLICTS OF INTEREST
• None
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ANATOMY
• Syndesmotic ligament complex
• Anterior inferior tibiofibular ligament (AITFL) – 35%
• Posterior inferior tibiofibular ligament (PITFL) – 42%
• Interosseous ligament (IL) – 22%
• Inferior transverse tibiofibular ligament *
Hsu, et al. Syndesmotic injuries in athletes. Op Tech Sports Med. 2014; 22 (4): 270-281.
Ogilvie-Harris Dj, Reed SC, Hedman TP. Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints. Arthroscopy .1994 Oct;10(5):558-60.
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DIAGNOSIS
• Signs and Symptoms:
• Persistent ankle pain
• Difficulty with uneven surfaces
• Sensation of ankle giving way
• Stiffness
• Limited dorsiflexion
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DIAGNOSIS
• Radiographic Exam:
• Tibiofibular clear space < 6 mm on AP and Mortise
• Tibiofibular overlap
• AP: >6 mm or >42% width of fibula
• Mortise: >1 mm
• Medial clear space ≤ superior clear space
• Advanced Imaging
• MRI
• CT
http://www.cmcedmasters.com/ortho-blog/the-adult-ankle
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DIAGNOSIS
• Exam
• External rotation stress test
• Squeeze test
• Cotton test
• Fibula translation test
• Arthroscopic evaluation
Johnson ZA, et al. Arthroscopic Stabilization for Chronic Latent Syndesmotic Instability. Arthroscopy Techniques, Vol. 5, No 2 (April), 2016: e262-e268
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SURGICAL TECHNIQUES
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LIGAMENTOPLASTY
Morris, Matthew William John et al. “Distal tibiofibular syndesmosis reconstruction using a free hamstring autograft.” Foot & ankle international 30 6 (2009): 506-11.
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TRANSLATIONAL OSTEOTOMY
Beaumer, et al. Late reconstruction of the anterior distal tibiofibular syndesmosis. Acta Orthop Scand 2000; 71 (5): 519-521
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SURGICAL TECHNIQUES
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SYNDESMOTIC FUSION
• Injuries > 6 months
• Begin 1 cm proximal to ankle joint
• 2-3 cm fusion site
• Bone graft
Penã FA, Coetzee JC. Ankle Syndesmosis Injuries. Foot Ankle Clin N Am. 11 (2006); 35-50.
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CASE EXAMPLE
• 44 y/o male
• Severe ankle sprain 3 years prior
• Complains of stiffness, pain with running and cutting
• Pain at anterolateral ankle/syndesmosis
• Positive external rotation stress test
• Abnormal CT scan
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CASE EXAMPLE
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CASE EXAMPLE
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SUMMARY AND PEARLS
• 6 weeks to 6 months – consider repair/reconstruction
• >6 months – Syndesmotic fusion
• When performing syndesmotic fusion
• Be aggressive in bone resection
• Grafting- size matters
• Avoid malreduction
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THANK YOU