O'Daly Andres Eduardo, Kreulen R Timothy, Thamyongkit Sorawut, Pisano Alfred, Luksameearunothai Kitchai, Hasenboehler Erik A, Helgeson Melvin D, Shafiq Babar
Coastal Orthopedics, Bradenton, FL, USA.
Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Foot Ankle Orthop. 2020 Nov 23;5(4):2473011420969140. doi: 10.1177/2473011420969140. eCollection 2020 Oct.
Stabilization methods for distal tibiofibular syndesmotic injuries present risk of malreduction. We compared reduction accuracy and biomechanical properties of a new syndesmotic reduction and stabilization technique using 2 suture buttons placed through a sagittal tunnel in the fibula and across the tibia just proximal to the incisura with those of the conventional method.
Syndesmotic injury was created in 18 fresh-frozen cadaveric lower leg specimens. Nine ankles were repaired with the conventional method and 9 with the new technique. Reduction for the conventional method was performed using thumb pressure under direct visualization and for the new method by tightening both suture buttons passed through the fibular and tibial tunnels. Computed tomography was used to assess reduction accuracy. Torsional resistance, fibular rotation, and fibular translation were evaluated during biomechanical testing.
The new technique showed less lateral translation of the fibula on CT measurements after reduction (0.06 ± 0.06 mm) than the conventional method (0.26 ± 0.31 mm), = .02. The new technique produced less fibular rotation during internal rotation after 0 cycles (new -2.4 ± 1.4 degrees; conventional -5.0 ± 1.2 degrees, = .001), 100 cycles (new -2.1 ± 1.9 degrees; conventional -4.6 ± 1.4 degrees, = .01), and 500 cycles (new -2.2 ± 1.6 degrees; conventional -5.3 ± 2.5 degrees, = .01) and during external rotation after 100 cycles (new 3.9 ± 3.3 degrees; conventional 5.9 ± 3.5 degrees, = .02) and 500 cycles (new 3.3 ± 3.2 degrees; conventional 6.3 ± 2.6 degrees, = .03). Fixation failed in 3 specimens.
The new syndesmotic reduction and fixation technique resulted in more accurate reduction of the fibula in the tibial incisura in the coronal plane and better rotational stability compared with the conventional method.
This new technique of syndesmosis reduction and stabilization may be a reliable alternative to current methods.
胫腓下联合损伤的稳定方法存在复位不良的风险。我们将一种新的胫腓下联合复位与稳定技术（通过在腓骨上的矢状隧道并穿过胫骨切迹近端的胫骨放置2个缝线纽扣）与传统方法在复位准确性和生物力学特性方面进行了比较。
在18个新鲜冷冻的尸体小腿标本上制造胫腓下联合损伤。9个踝关节采用传统方法修复，9个采用新技术修复。传统方法在直视下用拇指按压进行复位，新技术通过收紧穿过腓骨和胫骨隧道的两个缝线纽扣进行复位。采用计算机断层扫描评估复位准确性。在生物力学测试期间评估抗扭转性、腓骨旋转和腓骨平移。
新技术在复位后CT测量中显示腓骨的外侧平移（0.06±0.06mm）比传统方法（0.26±0.31mm）少，P = 0.02。在0个循环后的内旋过程中（新技术-2.4±1.4度；传统方法-5.0±1.2度，P = 0.001）、100个循环后（新技术-2.1±1.9度；传统方法-4.6±1.4度，P = 0.01）和500个循环后（新技术-2.2±1.6度；传统方法-5.3±2.5度，P = 0.01）以及在100个循环后的外旋过程中（新技术3.9±3.3度；传统方法5.9±3.5度，P = 0.02）和500个循环后（新技术3.3±3.2度；传统方法6.3±2.6度，P = 0.03），新技术产生的腓骨旋转较少。3个标本固定失败。
与传统方法相比，新的胫腓下联合复位与固定技术在冠状面使腓骨在胫骨切迹处的复位更准确，旋转稳定性更好。
这种新的胫腓下联合复位与稳定技术可能是当前方法的一种可靠替代方法。
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