Department Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA.
University Orthopaedic Center, University of Utah, Salt Lake City, UT; and.
J Orthop Trauma. 2022 Dec 1;36(12):658-664. doi: 10.1097/BOT.0000000000002443.
To evaluate reliability of measurement techniques for syndesmosis position after operative fixation of distal tibia plafond fracture on weight-bearing computed tomography (WBCT), identify risk factors for syndesmosis malposition, and determine if syndesmosis malposition is associated with higher pain and lower physical function.
Prospective cohort study.
Three Level 1 trauma centers.
Twenty-six subjects who underwent open reduction and internal fixation of distal tibia plafond fractures with bilateral ankle WBCT 1 year or greater after injury were included in the study.
Operative fixation of distal tibia plafond fracture.
Fibula position in the tibia incisura, injury characteristics, and patient-reported outcomes were the main outcome measurements.
Interrater reliability for syndesmosis position measurements were excellent for the Phisitkul technique on both injured and healthy ankles (intraclass correlation coefficients [ICCs]: 0.93-0.98). The Nault technique demonstrated moderate-to-excellent interrater reliability (ICCs: 0.67-0.98), apart from the angle of rotation measurement (ICCs: 0.18-0.67). Sixteen of 26 subjects (62%) had syndesmosis malposition defined as >2 mm difference comparing the tibial-fibular relationship in injured and uninjured ankles using these 2 methods. Patients with syndesmosis malposition reported lower Foot and Ankle Ability Measure: Activities of Daily Living scores; other recorded patient-reported outcomes were not significantly different.
Measurement techniques for syndesmosis position on WBCT were reliable after operative fixation of distal tibia plafond fracture. Syndesmosis malposition is common after these injuries and predicted impaired physical function.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估负重 CT（WBCT）术后固定下胫腓联合位置的测量技术的可靠性，确定下胫腓联合位置不良的危险因素，并确定下胫腓联合位置不良是否与更高的疼痛和更低的身体功能有关。
前瞻性队列研究。
三个 1 级创伤中心。
26 名受试者，他们在受伤后 1 年或更长时间进行了开放性复位和内固定下胫腓联合骨折，同时进行了双侧踝关节 WBCT。
下胫腓联合骨折的手术固定。
腓骨在胫骨切迹中的位置、损伤特征和患者报告的结果是主要的观察指标。
Phisitkul 技术在受伤和健康踝关节上测量下胫腓联合位置的组内相关系数（ICC）为 0.93-0.98，具有极好的测量者间可靠性。Nault 技术除了旋转角度测量（ICC：0.18-0.67）外，还具有中度至极好的测量者间可靠性（ICC：0.67-0.98）。使用这两种方法，26 名受试者中有 16 名（62%）存在下胫腓联合位置不良，定义为受伤和未受伤踝关节的胫腓骨关系差异>2mm。存在下胫腓联合位置不良的患者报告的足部和踝关节能力测量：日常生活活动评分较低；其他记录的患者报告的结果没有显著差异。
下胫腓联合位置的测量技术在术后固定下胫腓联合骨折后是可靠的。这些损伤后下胫腓联合位置不良很常见，并预测身体功能受损。
治疗水平 IV。有关证据水平的完整描述，请参见作者说明。
