2023 ARRS ANNUAL MEETING - ABSTRACTS

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ERS3065. Can Using the Contralateral Ankle to Assess Native Syndesmotic Laxity Predict Need for Syndesmotic Fixation?
Authors * Denotes Presenting Author
  1. Paul Allegra; Lenox Hill Hospital
  2. Danny Lee; University of Miami/Jackson Health System
  3. Gireesh Reddy; University of Miami/Jackson Health System
  4. Joseph Villavicencio *; University of Miami/Jackson Health System
  5. Joseph Geller; University of Miami/Jackson Health System
  6. Blake Hodgens; University of Miami
  7. Jean Jose; University of Miami
Objective:
Ankle fractures are one of the most frequently encountered musculoskeletal injuries and are often accompanied by distal tibiofibular syndesmotic disruption. Despite ample literature describing classification, management, and fixation strategies of ankle fractures, there is significant controversy regarding evaluation and fixation of the distal tibiofibular syndesmosis. Identification and stabilization of a co-existing syndesmotic injury is paramount to prevent ankle instability, pain, and ultimately post-traumatic arthritis. The purpose of this study is to use intraoperative fluoroscopy and a manual stress test to investigate whether the use of a patients uninjured contralateral ankle can serve as a reliable control to evaluate motion of the distal tibiofibular syndesmosis in the assessment of a co-existing syndesmotic injury ipsilateral to an ankle fracture.

Materials and Methods:
38 patients with a bimalleolar or trimalleolar ankle fracture from 12/2021 – 11/2022 who underwent operative fixation at our tertiary-care, level one trauma center, were identified and retrospectively reviewed. Patients 18 years of age or older without prior ankle fracture or known syndesmotic injury on the ipsilateral or contralateral side were included. Patient demographics, mechanism of injury, and whether syndesmotic fixation was performed during surgery was collected. Tibiofibular overlap and medial clear space widening of the injured ankle and the contralateral normal ankle were measured based on intraoperative mortise fluoroscopic images. We defined syndesmotic motion as the difference in tibiofibular overlap (TFO) measurements between stress and non-stress views in both injured and healthy ankles. Intraoperative mortise stress radiographs were obtained by placing the foot in neutral dorsal flexion and applying external rotation stress. Student's t-test was used to compare differences with parametric measurements. Matched pairs t-test analysis was performed comparing the difference in syndesmotic motion between healthy and injured ankles, as determined by an intraoperative mortise stress radiographs. P-value of <0.05 was considered significant.

Results:
The differences in syndesmotic motion between the injured ipsilateral and healthy contralateral ankles was 0.31 mm (p=0.0412). Amongst patients not requiring syndesmotic surgical fixation, the TFO mean difference between the injured ipsilateral and healthy contralateral ankle was -0.022 mm (p=0.8685). Amongst patients requiring syndesmotic surgical fixation, the TFO mean difference between the injured ipsilateral and healthy contralateral ankle was 0.757 mm (p=0.0346).

Conclusion:
We determined that there is very little motion in healthy contralateral ankles using intraoperative stress radiographs. Using the contralateral healthy ankle stress TFO is a reliable control are able to reliably determine whether syndesmotic fixation is required and perform fixation on the injured ankle.