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Mechanical considerations for the syndesmosis screw. A cadaver study
S D Boden1, P A Labropoulos, P McCowin
1Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, D.C. 20037.
The Journal of Bone and Joint Surgery. American Volume
|December 1, 1989
Summary
This study investigated the necessity of syndesmosis screws for treating pronation-external rotation ankle fractures. Findings suggest that in cases with deltoid ligament disruption, rigid fibular fixation alone may suffice.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Anatomy
Background:
- Pronation-external rotation ankle fractures often involve syndesmotic injury.
- Current treatment typically includes rigid internal fixation of the fibula and medial malleolus, often supplemented with a syndesmosis screw.
Purpose of the Study:
- To determine the mechanical necessity of syndesmosis screws in conjunction with rigid internal fixation for pronation-external rotation fractures.
- To evaluate the stability of fibular fixation when the syndesmosis is disrupted.
Main Methods:
- Utilized thirty-five cadaveric legs (embalmed and fresh) mounted for radiographic analysis.
- Simulated pronation-external rotation injuries by incrementally dividing the interosseous membrane and syndesmosis.
- Applied a standardized pronation-external rotation load and assessed syndesmotic widening via mortise radiographs.
Main Results:
- In Group I (simulated deltoid tear), rigid fibular fixation was achieved without a syndesmosis screw.
- The study modeled injuries including syndesmotic and interosseous membrane disruption up to the fibular fracture level.
Conclusions:
- The necessity of syndesmosis screws may depend on the integrity of the deltoid ligament.
- Rigid fixation of the fibula alone might be sufficient in specific pronation-external rotation fracture patterns with associated soft tissue injury.