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Diagnose: Bimmalleolaere Sprunggelenkluxationsfraktur Typ Weber B rechts mit Innenknoecheltruemmelfraktur, Syndesmosenruptur, Knorpeldefekt im Tibiaplateau ventromedial Uebergang zum Innenknoechel mit etwa 5 mm Durchmesser.
Sven Petersson Sweden Local time: 00:18 Native speaker of: Swedish, English PRO pts in pair: 1628
Explanation: Injuries of the Foot, Ankle and Leg
There is lateral ankle pain, swelling and a sense of instability. The anterior draw test is positive for ATFL injury and talar tilt (>45°) for CFL (Figs 111). X-rays are important to exclude fractures (eg Maisonneuve - where high fibular fractures and syndesmotic rupture). Stress X-rays may be helpful. www.worldortho.com/sportsmed/chap11.html
Syndesmotic Injury (DTFS)
· 18% of ankle injuries in football players have DTFS sprain
· DTFS is stabilized by four ligaments
· Mechanism of injury is forced external rotation of the foot with simultaneous internal rotation of the leg.
· Diagnosed by history and physical exam: point tenderness, squeeze test, Cotton test
· Rule out fractures since isolated syndesmotic rupture is rare. www.sfbay.net/spinalmedicine/articles/ankle_sprain.html
Hypotheses/Purpose: Deltoid ligament is an important structure whose integrity is important to establish in syndesmotic injury. The study was done to evaluate deltoid ligament mechanics when syndesmotic ligaments are disrupted.
Conclusions/Significance: This study confirms that the lateral shift of the talus which occurs with syndesmosis rupture is prevented by the deltoid ligament as is evident by the increase in the strain of the deltoid ligament with sectioning of the syndesmosis. This role of the deltoid ligament has been suggested previously by Close (3) and Grath (4). In cases of deltoid ligament injuries with ankle diastasis, the unrepaired syndesmosis provides unfavorable environment for ligament healing as it increases the strain. This has been suggested by Harper (5) in a clinical study in which nonoperative treatment of deltoid ligament ruptures with adequate syndesmotic fixation yielded good results. www.aofas.org/99winter/9902070935.asp
This last reference also mentions the syndesmotic screw:
Background: The objective of this study was to determine the level of the syndesmotic screw, the number of screws needed, and whether one or both cortices of tibia should be engaged to closely reproduce the physiological stability and elasticity of the ankle mortise in syndesmotic rupture after Maisonneuve fractures.
Material and Methods: Twelve fresh frozen cadaveric pairs of lower extremities were used for this study. The knee was exarticulated and soft tissue removed leaving the lateral and medial ankle ligaments intact. The tibiofibular syndesmosis was then sharply sectioned. All specimens were mounted in an Instron 2000 material testing machine. An axial loading of 500 N was applied. Syndesmotic diastasis was measured by a linear transducer system. The specimens were divided into three groups. In group I, the specimens were instrumented with one syndesmotic screw 2.5 cm above tibia plafond. In group II, the same procedure was performed as in group I with the syndesmotic screw positioned 4 cm above tibia plafond. In group III, the syndesmosis was fixed in each pair with two screws 2.5 and 4 cm above tibia plafond. In all groups, the screws were positioned randomly through three cortices on the one side and through four cortices on the contralateral side.
Results: Significant difference was observed between the application of one or two screws through three or four cortical shells on one side and the level of the screw on the other. www.europeantrauma.net/journal/regular_contents/detail/49/