Fri., 10/9/09 Pilon/Foot & Ankle, Paper #56, 4:17 pm OTA-2009
Syndesmotic Injuries: The Clinical Consequence of Mal-reduction at a Minimum of Two Year Follow-Up
Anjan R. Shah, MD (n); H. Claude Sagi, MD (7-Synthes);
Orthopaedic Trauma Service, Tampa General Hospital, Tampa, Florida, USA
Purpose: The clinical correlation of syndesmotic malreduction as identified by CT scan has not been previously reported. The goal of this study is to determine the incidence of malreduction (as determined by CT scan of both injured and noninjured ankles) and its effect on clinical and functional outcome in operatively treated syndesmotic injuries.
Methods: Inclusion criteria were skeletally mature patients with an isolated unilateral ankle injury. From January 2004 to January 2007, 68 ankles fractures in 68 patients underwent open reduction and internal fixation requiring syndesmotic joint reduction and fixation. Patients were reassessed after a minimum of 2 years both radio graphically (plain radiographs and CT scan of both ankles) and clinically (physical examination and functional outcome scores). Both general health (Short Musculoskeletal Function Assessment [SMFA]) and ankle-specific (Olerud and Molander) questionnaires were used. Reduction of the injured syndesmosis was evaluated by comparison to the uninjured ankle, and then correlated to the functional outcome scoring and results.
Results: Based on the CT evaluation, 39.1% of the syndesmotic injuries were malreduced. Patients with a malreduced syndesmosis scored poorer in both the general health questionnaire (SMFA) (27 ± 23.3 [malreduced group] vs 12 ± 10.6 [reduced group]), as well as in the ankle-specific (Olerud and Molander) questionnaire (46.3 ± 28.5 [malreduced group] vs 72.7 ± 22.5 [reduced group]), indicating significantly (P <0.05) worse functional outcomes in patients with malreduced syndesmotic injuries.
Conclusion: This is the first study, to our knowledge, that examines syndesmotic reduction with CT scanning, comparing to the uninjured contralateral extremity, and correlating reduction with functional outcome at a minimum of 2 years. In this series, 39% of syndesmotic injuries were malreduced. Patients with malreduced syndesmotic injuries had significantly worse functional outcomes as determined using the SMFA and Olerud/Molander scoring. It was also found that there exists a large variation between patients in what is the normal anatomy of the syndesmosis. Based on the findings of this study, we recommend open reduction of the syndesmosis under direct visualization and postoperative CT scanning comparing to the contralateral extremity. If the syndesmosis is found to be malreduced, consideration should be given to revising the reduction and fixation of the syndesmosis.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant