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Is It Possible to Overcompress the Syndesmosis?
Piyush Mahapatra1, Ben Rudge1, Paul Whittingham-Jones1
1Surgeon, Trauma and Orthopaedic Department, West Hertfordshire Hospital NHS Trust, Watford General Hospital, Watford, UK.
Summary
Overcompressing the syndesmosis during ankle fracture fixation can cause talar subluxation. Careful screw placement is crucial to avoid this complication and ensure proper ankle joint alignment.
Area of Science:
- Orthopedic Surgery
- Radiology
- Biomechanics
Background:
- Weber Type C ankle fractures often require surgical fixation, including syndesmotic stabilization.
- Current practices sometimes advocate for aggressive syndesmotic compression to ensure stability.
Observation:
- A patient with a Weber Type C ankle fracture developed anteromedial talar subluxation despite seemingly adequate fibular fixation.
- Computed tomography (CT) confirmed fibular alignment but did not explain the talar malpositioning.
Findings:
- Intraoperative examination revealed that sequential relaxation of the syndesmotic fixation reduced the talus within the ankle mortise.
- Restoration of the medial clear space and successful talar reduction were achieved by loosening the syndesmotic screws.
- A single screw in a reduced position stabilized the syndesmosis, leading to a full recovery.
Implications:
- This case highlights the potential risk of overcompressing the syndesmosis, leading to tibiotalar joint subluxation.
- Caution is advised regarding techniques that promote excessive syndesmotic compression, such as the lag screw technique.
- Optimal syndesmotic fixation may require a balance to avoid both instability and overcompression.
