Fluoroscopic Corner Congruency and Tibiotalar Symmetry Confirm Syndesmotic Reduction

Area of Science:

• Orthopedic surgery
• Radiology
• Biomechanical analysis

Background:

• Accurate reduction of syndesmotic injuries is crucial for optimal ankle function.
• Intraoperative assessment of syndesmotic reduction can be challenging.
• Existing radiographic markers require validation for reliability.

Purpose of the Study:

• To evaluate the accuracy of corner congruency (CC) and tibiotalar symmetry (TTS) radiographic markers.
• To determine their effectiveness in assessing anatomic syndesmotic reduction during surgery.

Main Methods:

• Eight cadaveric specimens were used for the study.
• Baseline and post-injury imaging (fluoroscopy, CT) were performed.
• Simulated malreductions and subsequent open reductions were assessed using CC and TTS markers.

Main Results:

• Individually, CC and TTS showed high specificity (100%) but variable sensitivity (62.5% and 75%, respectively).
• Malreduced syndesmotic injuries often showed incongruent CC and TTS markers.
• Combined CC and TTS markers demonstrated 100% sensitivity and specificity for anatomic reduction.

Conclusions:

• The combination of intact CC and TTS radiographic markers is a highly reliable predictor of anatomic syndesmotic reduction.
• These markers, when used together, provide a robust method for intraoperative assessment of syndesmotic repair.