1 Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
2 Tri-State Specialists, LLP, Sioux City, IA, USA.
Foot Ankle Int. 2019 Apr;40(4):465-474. doi: 10.1177/1071100718816037. Epub 2019 Jan 9.
: Fibular malreduction is becoming a commonly recognized complication of surgical repair of the syndesmosis when a reduction clamp is used. The goal of this work was to determine the interdependent effects of transsyndesmotic reduction clamp position and applied compression force on fibular alignment in a realistic cadaveric preparation of complete syndesmotic injury.
: Six through-the-knee cadaveric specimens were CT scanned intact, with the distal syndesmosis fully destabilized, and with 53, 102, and 160 N clamping forces each applied along an anteriorly, centrally, and posteriorly directed transsyndesmotic axis. Testing was repeated incorporating 178 N of Achilles tendon tension using all 3 clamping forces applied along the centrally directed axis. Fibular reduction was automatically quantified from CT scan-generated bony surfaces as rotation of the fibula around the tibia, rotation of the fibula within the incisura, medial/lateral fibular displacement, and anterior/posterior fibular displacement.
: Transsyndesmotic clamping along the anteriorly directed axis resulted in the best reduction quality by all 4 quantified measures. Along the centrally and posteriorly directed axes, progressively greater forces caused significantly greater sagittal plane fibular malreduction. Addition of Achilles tension reduced the magnitude of fibular malreduction and overcompression.
: Placing the medial tine of a transsyndesmotic reduction clamp on the anterior medial tibia resulted in the most accurate syndesmotic reduction and provided some protection against overcompression with large reduction clamp forces. Achilles tension appeared to contribute to reduction, decreasing the magnitude of measured malreduction from clamping.
: Previous studies estimating fibular malpositioning in cadaveric models that lacked passive muscle tension may have overestimated expected magnitudes of malalignment in patients treated with syndesmotic clamping. However, syndesmotic malreduction, particularly in the sagittal plane, was a real complication of syndesmotic clamping that was reduced by using an anterior position of the medial tine on the tibia.
当使用复位夹修复下胫腓联合时，腓骨复位不良已成为一种常见的并发症。本研究旨在确定在完全下胫腓联合损伤的逼真尸体模型中，经皮复位夹的位置和施加的压缩力对腓骨对线的相互影响。
对 6 例膝关节以下的尸体标本进行 CT 扫描，首先完整扫描，然后使远侧胫腓联合完全不稳定，然后分别施加 53、102 和 160 N 的夹力，沿前、中、后向经皮胫腓联合轴施加。使用所有 3 种夹力沿中央向轴施加 178 N 的跟腱张力后，重复测试。腓骨复位通过 CT 扫描生成的骨表面自动量化，表现为腓骨围绕胫骨的旋转、腓骨在切迹内的旋转、内外侧腓骨移位和前后侧腓骨移位。
在前向轴上沿经皮固定可通过 4 个量化指标获得最佳的复位质量。沿中央和后向轴，逐渐增加的力导致矢状面腓骨复位不良显著增加。跟腱张力的增加减少了腓骨复位不良的程度和过度压缩。
将经皮胫腓联合复位夹的内侧齿放在胫骨前内侧，可获得最准确的下胫腓联合复位，并为使用大复位夹力时防止过度压缩提供一定保护。跟腱张力似乎有助于复位，减少了夹闭时测量的复位不良程度。
以前的研究估计尸体模型中腓骨的位置不良，这些模型缺乏被动肌肉张力，可能高估了使用胫腓联合夹固定的患者的预期对线不良程度。然而，下胫腓联合复位不良，特别是矢状面，是经皮复位夹的一个真正并发症，在前侧胫骨上使用内侧齿可减少复位不良。
