Assessment of Open Syndesmosis Reduction Techniques in an Unbroken Fibula Model: Visualization Versus Palpation

This cadaveric study sought to evaluate the accuracy of syndesmotic reduction using direct visualization via an anterolateral approach compared with palpation of the syndesmosis through a laterally based incision.

Ten cadaveric specimens were obtained and underwent baseline computed tomography (CT) scans. Subsequently, a complete syndesmotic injury was simulated by transecting the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, transverse ligament, interosseous membrane, and deltoid ligament. Three orthopaedic trauma surgeons were then asked to reduce each syndesmosis using direct visualization via an anterolateral approach. Specimens were then stabilized and underwent postreduction CT scans. Fixation was then removed, the anterolateral exposure was closed, and the surgeons were then asked to reduce the syndesmosis using palpation only via a direct lateral approach. Specimens were again instrumented and underwent postreduction CT scans. Two-tailed paired t tests were used to compare reductions with baseline scans with significance set at P < 0.05.

There was no statistically significant difference between reduction via direct visualization or palpation via lateral approach when compared with baseline scans. Although measurements did not reach significance, there was a tendency toward external rotation, and anteromedial translation with direct visualization, and a trend toward fibular external rotation and posterolateral translation with palpation.

There is no difference in reduction quality using direct visualization or palpation to assess the syndesmosis. Surgeons may therefore choose either technique when reducing syndesmotic injures based on personal preference and other injury factors.