Morphology of Fibular Incisura is a Deciding Factor Between Posterior Malleolus Avulsion Fracture or Syndesmotic Ligament Injury in Ankle Fractures.

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Abstract

[Indexed for MEDLINE] 19. Eur J Trauma Emerg Surg. 2023 Aug;49(4):1883-1890. doi: 10.1007/s00068-023-02256-2. Epub 2023 Apr 18. Preoperative CT parameters to predict tibiofibular syndesmosis injury associated with ankle fracture: a propensity score-matched analysis. Lei Q(#)(1), Chen P(#)(1)(2)(3)(4), He X(1)(2)(3)(4), Xu Z(5)(6)(7)(8), He W(9)(10)(11)(12). Author information: (1)Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China. (2)Department of Emergency Trauma Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China. (3)Fujian Trauma Medicine Center, Fuzhou, 350001, Fujian, China. (4)Fujian Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China. (5)Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China. xzx886@126.com. (6)Department of Emergency Trauma Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China. xzx886@126.com. (7)Fujian Trauma Medicine Center, Fuzhou, 350001, Fujian, China. xzx886@126.com. (8)Fujian Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China. xzx886@126.com. (9)Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China. hewb120@sina.com. (10)Department of Emergency Trauma Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China. hewb120@sina.com. (11)Fujian Trauma Medicine Center, Fuzhou, 350001, Fujian, China. hewb120@sina.com. (12)Fujian Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China. hewb120@sina.com. (#)Contributed equally BACKGROUND: Untreated ankle fractures with concomitant tibiofibular syndesmosis injury often lead to postoperative pain and early traumatic arthritis. CT has advantages in the preoperative diagnosis of combined ankle injuries. However, a few studies have investigated the best preoperative CT parameters to predict tibiofibular syndesmosis injuries associated with ankle fractures. This study aimed to identify and evaluate the optimal preoperative CT parameters for predicting tibiofibular syndesmosis injuries associated with ankle fractures. METHODS: We retrospectively analyzed 129 patients who underwent preoperative CT of an ankle fracture treated between January 2016 and April 2022 at a tertiary A hospital. All patients underwent open reduction and internal fixation and intraoperative stability testing. Based on the Cotton test, the patients were divided into the stable group (n = 83, 64.3%) and unstable group (n = 46, 35.7%). After 1:1 propensity score matching, the general conditions, anterior tibiofibular distance (TFD), posterior TFD, maximum TFD, tibiofibular syndesmosis area, sagittal fracture angle, Angle-A, and Angle-B were compared between the stable and unstable groups. RESULTS: The propensity score-matched cohort comprised 82 patients. There were no significant differences between the stable and unstable groups in sex, age, affected side, operation interval, injury mechanism, Lauge-Hansen classification, sagittal fracture angle, and Angle-A (all P > 0.05). Compared with the stable group, the unstable group had a significantly greater aTFD, pTFD, maxTFD, and area (all P