Endoscopic detection of syndesmosis damages in patients with ankle fractures including external rotation
DOI:
https://doi.org/10.56294/hl2025629Keywords:
Syndesmosis Injury, Ankle Fracture, Intraoperative Assessment, Sensitivity and Specificity, FluoroscopyAbstract
Background: Syndesmosis injury is a frequent and severe complication in the setting of ankle fracture, especially external rotation-type. Early, precise diagnosis is necessary for proper management to avoid long-term disability. Intraoperative Syndesmosis integrity assessment is important in planning the need for surgery.
Aim: The purpose of the research is to assess the efficacy of intraoperative diagnostic techniques in diagnosing Syndesmosis injuries in patients with ankle fractures caused by external rotation, and to evaluate the precision of clinical assessment, imaging modalities, and direct intraoperative evaluation. 100 patients were enrolled in the research to provide credible and statistically significant results.
Methods: A group of 100 patients with ankle fracture, i.e., those due to external rotation mechanisms, was evaluated by clinical examination, preoperative imaging (CT scans, MRI), and intraoperative testing (stress tests, fluoroscopy). Surgical exploration was used to confirm intraoperative diagnosis. Sensitivity, specificity, and accuracy of all the methods were compared to decide the most appropriate diagnostic method.
Results: The intraoperative assessment was most accurate in diagnosing Syndesmosis injuries than preoperative imaging and clinical examinations. Stress tests and fluoroscopic control were most useful in detecting subtle syndesmotic disruptions, with a sensitivity of 92.7% and specificity of 86.7%. Preoperative imaging had moderate accuracy, while clinical examinations were less accurate in detecting occult injuries.
References
1. Yoon HJ, Kim S, Kim JH, Keum JS, Oh SI, Jo J, Chun J, Youn YH, Park H, Kwon IG, Choi SH. A lesion-based convolutional neural network improves endoscopic detection and depth prediction of early gastric cancer. Journal of clinical medicine. 2019 Aug 26;8(9):1310.https://doi.org/10.3390/jcm8091310
2. Ozawa T, Ishihara S, Fujishiro M, Kumagai Y, Shichijo S, Tada T. Automated endoscopic detection and classification of colorectal polyps using convolutional neural networks. Therapeutic advances in gastroenterology. 2020 Mar;13:1756284820910659.https://doi.org/10.1177/1756284820910659
3. Chun DI, Kim J, Kim YS, Cho JH, Won SH, Park SY, Yi Y. Relationship between fracture morphology of lateral malleolus and syndesmotic stability after supination-external rotation type ankle fractures. Injury. 2019 Jul 1;50(7):1382-7.https://doi.org/10.1016/j.injury.2019.05.020
4. Birnie MF, van Schilt KL, Sanders FR, Kloen P, Schepers T. Anterior inferior tibiofibular ligament avulsion fractures in operatively treated ankle fractures: a retrospective analysis. Archives of orthopaedic and trauma surgery. 2019 Jun 1;139:787-93.https://doi.org/10.1007/s00402-019-03138-2
5. Corte-Real N, Caetano J. Ankle and Syndesmosis instability: consensus and controversies. EFORT open reviews. 2021 Jun 28;6(6):420-31.https://doi.org/10.1302/2058-5241.6.210017
6. Xu HL, Song YJ, Hua YH. Reconstruction of chronic injured distal tibiofibular Syndesmosis with autogenous tendon graft: a systematic review. BioMed Research International. 2021;2021(1):3182745.https://doi.org/10.1155/2021/3182745
7. Shibata T, Teramoto A, Yamada H, Ohmiya N, Saito K, Fujita H. Automated detection and segmentation of early gastric cancer from endoscopic images using mask R-CNN. Applied Sciences. 2020 Can 31;10(11):3842.https://doi.org/10.3390/app10113842
8. El-Barbarey AN, El-Tarawy AI, Zayda AI, El-Serwy BE. One-screw versus two-screw fixation of Syndesmosis in bimalleolar ankle fractures associated with syndesmotic injury. Menoufia Medical Journal. 2022;35(3):1555-60.https://doi.org/10.4103/mmj.mmj_88_22
9. Hickey B, Dalmau-Pastor M, Karlsson J, Calder J. Hindfoot endoscopic release of the posterior ankle capsuloligamentous structures improves ankle dorsiflexion range, function and pain in patients with painful limitation of ankle dorsiflexion. Journal of ISAKOS. 2020 Jan 1;5(1):21-5.https://doi.org/10.1136/jisakos-2019-000338
10. Diniz P, Sousa DA, Batista JP, Abdelatif N, Pereira H. Diagnosis and treatment of anterior ankle impingement: state of the art. Journal of ISAKOS. 2020 Sep 1;5(5):295-303.https://doi.org/10.1136/jisakos-2019-000282
11. Vega J, Allmendinger J, Malagelada F, Guelfi M, Dalmau-Pastor M. Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Jan;28:132-40.https://doi.org/10.1007/s00167-017-4736-y
12. Lucenti L, Testa G, Nocera C, Culmone A, Dell’Agli E, Pavone V. Bosworth fractures of the ankle: a systematic literature review. Journal of Personalized Medicine. 2023 Apr 23;13(5):713.https://doi.org/10.3390/jpm13050713
13. D’Hooghe P, Bouri F, Eleftheriou A, Baltes TP, Alkhelaifi K. Ankle Fractures and Return to Sports in Athletes:“Does Arthroscopy Add Value to the Treatment?”. Sports Injuries of the Foot and Ankle: A Focus on Advanced Surgical Techniques. 2019:167-81.https://doi.org/10.1007/978-3-662-58704-1_16
14. Shoji H, Sugimoto K, Isomoto S, Miura K, Tanaka Y. Fibrocartilaginous Bed Injury of the Posterior Tibial Tendon Sheath: A Report of 3 Cases. JBJS Case Connector. 2022 Oct 1;12(4):e22.DOI: 10.2106/JBJS.CC.22.00340
15. Abdelatif NM, Batista JP. Endoscopic flexor hallucis longus transfer for the management of acute Achilles tendon ruptures in professional soccer players. Foot & Ankle International. 2022 Feb;43(2):164-75.https://doi.org/10.1177/10711007211036439
16. Green SA. Orthopaedic Surgeons: Inheritors of Tradition. Clinical Orthopaedics and Related Research (1976-2007). 1999 Jun 1;363:258-69.
17. Paisa R. The Musical Touch: Exploring Vibrotactile Augmentation of Music for Cochlear Implant Users. https://doi.org/10.54337/aau708324153
18. Bawady A, Allam A, Karamany M, Farag H. Tight rope versus screw fixation in ankle syndesmotic injuries. Benha Medical Journal. 2023 Jan 1;40(Special issue (Surgery)):112-28. https://doi.org/10.21608/bmfj.2022.20545.1183
19. Jonkergouw N, Sprockel AT, Bruijn SM, Kooiman V, Prins MR, Leijendekkers RA. The significance of frontal plane static alignment in anticipating dynamic knee moment among transtibial prosthesis users: A cross-sectional study. Gait & Posture. 2024 Jul 1;112:128-33. https://doi.org/10.1016/j.gaitpost.2024.05.012
20. Warner SJ, Garner MR, Fabricant PD, Schottel PC, Loftus ML, Hentel KD, Helfet DL, Lorich DG. The diagnostic accuracy of radiographs and magnetic resonance imaging in predicting deltoid ligament ruptures in ankle fractures. HSS Journal®. 2019 Jul;15(2):115-21.https://doi.org/10.1007/s11420-018-09655-x
21. Lentle B, Koromani F, Brown JP, Oei L, Ward L, Goltzman D, Rivadeneira F, Leslie WD, Probyn L, Prior J, Hammond I. The radiology of osteoporotic vertebral fractures revisited. Journal of Bone and Mineral Research. 2019 Mar 1;34(3):409-18.https://doi.org/10.1002/jbmr.3669
22. Carter TH, Duckworth AD, White TO. Medial malleolar fractures: current treatment concepts. The Bone & Joint Journal. 2019 Can 1;101(5):512-21.doi:10.1302/0301-620x.101B5.BJJ-2019-0070
23. Peña FA, Coetzee JC. Ankle Syndesmosis injuries. Foot and ankle clinics. 2006 Mar 1;11(1):35-50.https://doi.org/10.1016/j.fcl.2005.12.007
24. Pollard N, Lincoln M, Nisbet G, Penman M. Patient perceptions of communication with diagnostic radiographers. Radiography. 2019 Nov 1;25(4):333-8.https://doi.org/10.1016/j.radi.2019.04.002
25. Pitakveerakul A, Kungwan S, Arunakul P, Arunakul M. Radiographic parameters in gravity stress view of the ankle: normative data. Foot and Ankle Surgery. 2019 Dec 1;25(6):819-25.https://doi.org/10.1016/j.fas.2018.10.011
26. Tourné Y, Molinier F, Andrieu M, Porta J, Barbier G. Diagnosis and treatment of tibiofibular Syndesmosis lesions. Orthopaedics& Traumatology: Surgery & Research. 2019 Dec 1;105(8):S275-86.https://doi.org/10.1016/j.otsr.2019.09.014
27. Yu GS, Lin YB, Xiong GS, Xu HB, Liu YY. Diagnosis and treatment of ankle Syndesmosis injuries with associated interosseous membrane injury: a current concept review. International orthopaedics. 2019 Nov;43:2539-47.https://doi.org/10.1007/s00264-019-04396-w
28. Gosselin-Papadopoulos N, Hébert-Davies J, Laflamme GY, Ménard J, Leduc S, Nault ML. A new and more sensitive view for the detection of syndesmotic instability. Journal of Orthopaedic Trauma. 2019 Sep 1;33(9):455-9.DOI: 10.1097/BOT.0000000000001495
29. Raheman FJ, Rojoa DM, Hallet C, Yaghmour KM, Jeyaparam S, Ahluwalia RS, Mangwani J. Can weightbearing cone-beam CT reliably differentiate between stable and unstable syndesmotic ankle injuries? A systematic review and meta-analysis. Clinical Orthopaedics and Related Research®. 2022 Aug 1;480(8):1547-62. DOI: 10.1097/CORR.0000000000002171
30. Bastias GF, Filippi J. Acute deltoid ligament repair in ankle fractures. Foot and Ankle Clinics. 2020 Dec 1;25(4):597-612.https://doi.org/10.1016/j.fcl.2020.08.009.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Sudhanshu Dev, Santosh Kumar Sahu, Sujeet Singh , Nishant Gaonkar, Sorabh Sharma, Mittapalli Premchandh (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
