Acute distal fibula fracture9/25/2023 ![]() ![]() Secondary goals were to determine the correlation between the radiographic measurements and fracture treatment in relation to syndesmotic injury. The primary goal of this study was to correlate three common clinical fracture classification systems with MR findings, regarding injury of the syndesmosis in acute ankle fractures. MR imaging enables identification of syndesmotic injuries that were not diagnosed at the initial radiographs and clinical examination. Subsequently the patient is not treated properly, leading to chronic complaints such as instability, pain, swelling, and early osteoarthritis. Owing to the shortcomings of clinical examination and radiographs, injury to the syndesmotic ligaments is often misdiagnosed. Īs it is difficult to assess injury to the syndesmosis on radiographs, the true incidence is a matter of speculation. A medial clear space (MCS) surpassing the tibial clear space (TCS) is indicative of deltoid injury, which regularly accompanies injury of the syndesmosis. Absence of tibiofibular overlap (TFO) at one side and a tibiofibular clear space (TFCS) larger than 6 mm may be an indication of syndesmotic injury. Lauge-Hansen describes the trauma mechanism of ankle fractures, based on the position of the foot at the time of injury and the direction in which the talus moves within the ankle mortise.Īdditionally a number of radiographic parameters are used to evaluate the integrity of the syndesmotic and deltoid ligaments. According to Weber and AO-Müller, a fracture is classified based on the level of the fibular fracture in relation to the syndesmotic ligaments. Three frequently used methods to describe ankle fractures are the Danis-Weber, AO-Müller, and Lauge-Hansen fracture classifications. The classification of malleolar fractures constitutes the basis for treatment of acute ankle fractures. There are four syndesmotic ligaments: the anterior distal tibiofibular ligament (ATIFL) and posterior distal tibiofibular ligament (PTIFL), which attach the anterior and posterior tibial and fibular tubercles, respectively, and the interosseous ligament (IOL), which is the thickened continuation of the interosseous membrane (IOM), and the transverse ligament extending between the malleolar fossa of the fibula and the dorsal rim of the distal tibia. The lateral malleolus of the fibula is firmly held in the fibular notch of the tibia, providing a tight elastic ankle mortise. As the major stabilizer of the distal tibiofibular joint, the ligamentous complex of the syndesmosis is critical in maintaining normal ankle function. Treatment of ankle fractures is determined by several factors such as patient age, soft tissue status, dislocation of the fracture, and integrity of the distal tibiofibular syndesmosis. With MRI the extent of syndesmotic injury and therefore fracture stage can be assessed more accurately compared to radiographs. Syndesmotic injury as predicted by the Lauge-Hansen fracture classification correlated well with MRI findings. TFCS and TFO did not correlate with syndesmotic injury, and a widened MCS did not correlate with deltoid ligament injury. The Weber and AO-Müller fracture classification system, in combination with additional measurements, detected syndesmotic injury with a sensitivity of 47% and a specificity of 100%, and Lauge-Hansen with both a sensitivity and a specificity of 92%. The sensitivity and specificity for detection of syndesmotic injury with radiography were compared to MRI. MRI, as standard of reference, was performed to evaluate the integrity of the distal tibiofibular syndesmosis. Both the fracture type and additional measurements of the tibiofibular clear space (TFCS), tibiofibular overlap (TFO), medial clear space (MCS), and superior clear space (SCS) were used to assess syndesmotic injury. Prospectively the radiographs of 51 consecutive ankle fractures were classified according to Weber, AO-Müller, and Lauge-Hansen. We evaluated three fracture classification methods and radiographic measurements with respect to syndesmotic injury. Subsequently the patient is not treated properly leading to chronic complaints such as instability, pain, and swelling. When there is no indication requiring that the fractured ankle be operated on, the syndesmosis is not tested intra-operatively, and rupture of this ligamentous complex may be missed. ![]()
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