Arvind Kumar1, Lakshay Goel2, Dushyant Chouhan3, Akhil Agnihotri4, Shishir Chauhan5, Jigyasa Passey6. 1. Department of Orthopedics, Hamdard Institute of Medical Sciences and Research, New Delhi, 110062, India. 2. Central Institute of Orthopedics, VMMC, New Delhi, India. 3. Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India. 4. Sports Injury Centre, VMMC, New Delhi, India. 5. Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India. 6. Department of Anatomy, Maulana Azad Medical College, New Delhi, India.
Abstract
PURPOSE: The risk of malpositioning of the syndesmotic screws is very high. A lack of standard radiological or physical references for accurate syndesmotic screw placement is a potential contributing factor in syndesmotic screw malpositioning. Malleolar tips are clinically as well as radiologically appreciable bony references. The purpose of this preliminary CT based study was to investigate the axial relations of the central syndesmotic axis with the malleolar tips. METHODS: CT based studies of uninjured adult ankle joints with intact syndesmosis, conducted over a six months period were analysed. The axial differences between the coronal plane along the malleolar tips and that along the central syndesmotic axis in the axial plane were measured. Gender-based variations were also analyzed. RESULTS: A total of 70 CT studies were analyzed, and the axial difference between the malleolar tips based coronal plane and that along the central syndesmotic axis was observed to be 3.70 ± 5.61°. The male and female measurements were comparable. CONCLUSION: Being in a static relation to the syndesmosis independent of the foot position and the limb rotation, the malleolar tips can be reliably used as references for directing syndesmotic screw in the axial plane. A knowledge of this axial difference between malleolar tips and central syndesmotic axis can help surgeons in an accurate syndesmotic screw placement.
PURPOSE: The risk of malpositioning of the syndesmotic screws is very high. A lack of standard radiological or physical references for accurate syndesmotic screw placement is a potential contributing factor in syndesmotic screw malpositioning. Malleolar tips are clinically as well as radiologically appreciable bony references. The purpose of this preliminary CT based study was to investigate the axial relations of the central syndesmotic axis with the malleolar tips. METHODS: CT based studies of uninjured adult ankle joints with intact syndesmosis, conducted over a six months period were analysed. The axial differences between the coronal plane along the malleolar tips and that along the central syndesmotic axis in the axial plane were measured. Gender-based variations were also analyzed. RESULTS: A total of 70 CT studies were analyzed, and the axial difference between the malleolar tips based coronal plane and that along the central syndesmotic axis was observed to be 3.70 ± 5.61°. The male and female measurements were comparable. CONCLUSION: Being in a static relation to the syndesmosis independent of the foot position and the limb rotation, the malleolar tips can be reliably used as references for directing syndesmotic screw in the axial plane. A knowledge of this axial difference between malleolar tips and central syndesmotic axis can help surgeons in an accurate syndesmotic screw placement.
Authors: Tim Schepers; Hans van der Linden; Esther M M van Lieshout; Dieu-Donné Niesten; Maarten van der Elst Journal: Injury Date: 2013-09-27 Impact factor: 2.586