Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Βλάμης Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Πνευματικός Σπυρίδων, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βασιλειάδης Ηλίας, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαυρογένης Ανδρέας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χρονόπουλος Ευστάθιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικολάου Βασίλειος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευαγγελόπουλος Δημήτριος-Στέργιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Ο ρόλος της επισκόπησης του χώρου incisura μέσω αρθροτομής στην ορθή ανάταξη της κνημοπερονιαίας συνδέσμωσης στα κατάγματα ποδοκνημικής
Translated title:
The role of incisura inspection via arthrotomy in optimal distal syndesmotic reduction in ankle fractures
Summary:
Introduction: Distal tibiofibular joint injury is quite common in rotational ankle fractures, with high malreduction rates reported. Although several intraoperative techniques evaluate the optimal tibiofibular reduction, they are critically debated due to high error rates and subjective interpretation of the results. For this reason, we attempted to describe specific anatomical landmarks and anatomical relationships of the ankle through ankle joint arthrotomy and inspection of the anterior incisura fibularis corner and further evaluate their reliability regarding optimal tibiofibular reduction.
Materials and Methods: The study consists of two phases. We initially submitted patients with bimalleolar ankle fractures and tibiofibular instability to internal fixation through our proposed surgical approach and technique. We then compared the quality of reduction with the normal contralateral ankles of the same patients by computed tomography. In the second phase, the safety and effectiveness of the technique were tested in the general population in patients with rotational fractures and concomitant tibiofibular instability. Patients were randomized into two groups, and the results of the proposed technique (Group A) were compared with those of standard surgical management (Group B). In the evaluation, the reduction efficiency between the two techniques was compared.
Results: During the first phase of the study, we compared the quality of tibiofibular joint reduction in 40 patients with their healthy, unaffected ankle. We found that none of the tested parameters showed a significant difference, which confirmed that the proposed surgical technique achieves anatomical reduction of the fractures. In the second phase of the study, we compared our technique with the standard approach, evaluating the fracture reduction and tibiofibular instability assessment. We found that the standard approach resulted in a statistically significant difference in fibular rotation compared to the controlled technique. We also observed a trend of shortened
fibular fixation in patients who received the standard approach compared to those who received our technique. Finally, we evaluated the clinical outcomes of patients in both groups during the postoperative follow-up. We found that the clinical evaluation of patients who received our technique was significantly better at all stages of postoperative follow-up compared to those who received the standard approach.
Discussion: The proposed surgical technique, which involves modifying the approach and reducing the distal tibiofibular ligament while considering the anatomic relationships, has been proven to be safe and reliable. It is superior to the standard treatment, significantly reducing the need for intraoperative radiation. Additionally, patients treated with this technique have a significantly better clinical evaluation up to the first postoperative year.
Main subject category:
Health Sciences
Keywords:
Syndesmosis, Tibiofibular, Ankle fractures, Ankle instability, Internal fixation
Number of references:
203
