Pallis Mark P, Pressman David N, Heida Kenneth, Nicholson Tyler, Ishikawa Susan
1 William Beaumont Army Medical Center, El Paso, TX, USA.
2 Hope Orthopedics of Oregon, Salem, OR, USA.
Foot Ankle Int. 2018 Jun;39(6):746-750. doi: 10.1177/1071100718759966. Epub 2018 Mar 30.
Anatomic reduction and fixation of the syndesmosis in traumatic injuries is paramount in restoring function of the tibiotalar joint. While overcompression is a potential error, recent work has called into question whether ankle position during fixation really matters in this regard. Our study aimed to corroborate more recent findings using a fracture model that, to our knowledge, has not been previously tested.
Twenty cadaver leg specimens were obtained and prepared. Each was tested for tibiotalar motion under various conditions: intact syndesmosis, intact syndesmosis with lag screw compression, pronation external rotation type 4 (PER-4) ankle fracture with syndesmotic disruption, and single-screw syndesmotic fixation followed by plate and screw fracture and syndesmotic screw fixation. In each situation, the ankle was held in alternating plantarflexion and dorsiflexion when inserting the syndesmotic screw with the subsequent amount of maximal dorsiflexion being recorded following hand-tight lag screw fixation.
While ankle range of motion increased significantly with creation of the PER-4 injury, under no condition was there a statistically significant change in maximal dorsiflexion angle.
Ankle position during distal tibiofibular syndesmosis fixation did not limit dorsiflexion of the ankle joint.
Our findings suggest that maximal dorsiflexion during syndesmotic screw fixation may not be necessary.
创伤性损伤中联合韧带的解剖复位和固定对于恢复胫距关节功能至关重要。虽然过度加压是一种潜在的失误，但最近的研究对固定过程中踝关节位置在这方面是否真的重要提出了质疑。我们的研究旨在使用一种据我们所知此前未经过测试的骨折模型来证实最新的研究结果。
获取并准备了20个尸体小腿标本。对每个标本在各种情况下进行胫距关节活动测试：联合韧带完整、联合韧带完整并使用拉力螺钉加压、旋前外旋IV型（PER-4）踝关节骨折伴联合韧带断裂，以及单螺钉联合韧带固定后进行钢板螺钉骨折和联合韧带螺钉固定。在每种情况下，插入联合韧带螺钉时踝关节交替处于跖屈和背屈状态，在手动拧紧拉力螺钉固定后记录随后的最大背屈量。
虽然随着PER-4损伤的形成踝关节活动范围显著增加，但在任何情况下最大背屈角度均无统计学上的显著变化。
胫腓下联合韧带固定过程中踝关节位置并不限制踝关节的背屈。
我们的研究结果表明联合韧带螺钉固定过程中可能无需达到最大背屈。
