Measurement of fibular rotation angle: Intraoperative judgment of the success rate of inferior tibiofibular syndesmosis reduction

doi:10.3969/j.issn.2095-4344.2013.26.016

Abstract

Abstract:

BACKGROUND: The CT image is better than X-ray plain film in diagnosing inferior tibiofibular syndesmosis, but the research on CT diagnostic criteria for the diagnose of inferior tibiofibular syndesmosis rotation mismatch is rare. At present, there lacks of systematic research on inferior tibiofibular joint three-dimensional mismatch at home and abroad, especially for the measurement of rotational relationship.
OBJECTIVE: To measure the tibiofibular rotation angle of tibiofibular syndesmosis in normal people with CT imaging.
METHODS: Twenty-one male and 21 female volunteers were collected for test, and the CT scan was performed to scan the ankle joint. Axial CT measurements included the anterior tibiofibular interval, posterior tibiofibular interval, fibula rotation angle, tibiofibular articular surface tangent angle and tibia Philippians articular surface tangent angle. Two researchers accomplished the measurement at three different occasions independently, and evaluated each CT data.
RESULTS AND CONCOUSION: A total of 42 ankles enrolled in the study of data analysis. The tibial surface shape of the tibiofibular syndesmosis was described as deep curved, shallow arc, shallow sloping and flat-shaped. The deep curved symmetrical sydesmosis was the most common type. The shape of fibula was divided into triangular, circular, elliptical, and the most common shape was triangle. Each measurement data was in 95% confidence interval: the anterior tibiofibular interval was 2.10-2.25 mm, the posterior tibiofibular interval was 4.14-4.29 mm, fibula rotation angle was 103.97°-106.30°, tibiofibular articular surface tangent angle was 21.88°-26.64°, tibia Philippians articular surface tangent angle was 33.03°-36.63°. The fibula rotation angle had the smallest variation coefficient with relative small fluctuations and was more representative. The fibular rotational angle was the most stable parameter when comparing with the rest parameters. These data in the study provided the data base with regarding to the precise reduction of the tibiofibular syndesmosis.

Key words: bone and joint implants, basic experiment of bone injury, tibiofibular syndesmosis, CT measurement, fibula rotation angle, coefficient of variation, provincial grants-supported paper

CLC Number:

R318

Ruan Zhi-yong, Huang Jin-liang, Luo Cong-feng. Measurement of fibular rotation angle: Intraoperative judgment of the success rate of inferior tibiofibular syndesmosis reduction[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.26.016.

Figures/Tables 5

References

[1] Jensen SL, Andresen BK, Mencke S, et al. Epidemiology of ankle fractures. A prospective population-based study of 212 cases in Aalborg, Denmark. Acta Orthop Scand. 1998; 69(1): 48-50.

[2] Beumer A, van Hemert W L, Niesing R, et al. Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res. 2004;423:227-234.

[3] Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. 2012;26(7):439-443.

[4] Pei GX. Zhonghua Chuangshang Guke Zazhi. 2011; 13(12): 1-3.裴国献.数字化技术与骨科学的融汇-数字骨科学-写在中华医学会医学工程学分会数字骨科学组成立之际[J].中华创伤骨科杂志, 2011,13(12):1-3.

[5] Sun MJ, Zhou YG, Wang Y, et al. Zhonghua Waike Zazhi. 2008;46(19): 1507-1508.孙明举,周勇刚,王岩,等.正常成人双侧下胫腓联合间隙参数指标的CT测量及临床意义[J].中华外科杂志,2008,46(19): 1507-1508.

[6] Zhang Q, Hou XK, Luo JC. ZHongguo Jiaoxing Waike Zazhi. 2005;13(20): 1565-1567.张庆,侯筱魁,罗济程.下胫腓联合的CT测量[J].中国矫形外科杂志,2005,13(20): 1565-1567

[7] Kendoff D, Citak M, Gardner MJ, et al. Intraoperative 3D imaging: value and consequences in 248 cases. J Trauma. 2009;66(1):232-238.

[8] Richter M, Zech S. Intraoperative 3-dimensional imaging in foot and ankle trauma-experience with a second-generation device (ARCADIS-3D). J Orthop Trauma. 2009;23(3):213- 220.

[9] Ruan Z, Luo C, Shi Z, et al. Intraoperative reduction of distal tibiofibular joint aided by three-dimensional fluoroscopy. Technol Health Care. 2011;19(3):161-166.

[10] Boruta PM, Bishop JO, Braly WG, et al. Acute lateral ankle ligament injuries: a literature review. Foot Ankle. 1990;11(2): 107-113.

[11] Kannus P, Renstrom P. Treatment for acute tears of the lateral ligaments of the ankle. Operation, cast, or early controlled mobilization. J Bone Joint Surg Am. 1991;73(2):305-312.

[12] Ferran NA, Maffulli N. Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin. 2006;11(3):659-662.

[13] Auleley GR, Kerboull L, Durieux P, et al. Validation of the Ottawa ankle rules in France: a study in the surgical emergency department of a teaching hospital. Ann Emerg Med. 1998;32(1):14-18.

[14] Beris AE, Kabbani KT, Xenakis TA, et al. Surgical treatment of malleolar fractures. A review of 144 patients. Clin Orthop Relat Res. 1997;341:90-98.

[15] Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures--an increasing problem?. Acta Orthop Scand. 1998; 69(1):43-47.

[16] Ebraheim NA, Taser F, Shafiq Q, et al. Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments. Surg Radiol Anat. 2006;28(2):142-149.

[17] Grass R, Rammelt S, Biewener A, et al. Peroneus longus ligamentoplasty for chronic instability of the distal tibiofibular syndesmosis. Foot Ankle Int. 2003;24(5):392-397.

[18] Dikos GD, Heisler J, Choplin RH, et al. Normal tibiofibular relationships at the syndesmosis on axial CT imaging. J Orthop Trauma. 2012;26(7):433-438.

[19] Williams GN, Allen EJ. Rehabilitation of syndesmotic (high) ankle sprains. Sports Health. 2010;2(6):460-470.

[20] Zhang P. Diagnosis and treatment for distal tibiofibular diastasis in the malleolus joint injuries. Zhongguo Gu Shang. 2009b;22(2):137.

[21] Blomfldt R, Tomkvist H, Ponzer S, et al. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am. 2005;87: 1680-1688.

[22] Qin Y, Henry DeGroot Ⅲ. Zhongguo Jiaoxing Waike Zazhi. 2008,16(22):1685-1688.秦煜,Henry DeGroot Ⅲ. Suture Button装置修复下胫腓联合损伤的初步报告[J]. 中国矫形外科杂志, 2008,16(22):1685-1688.

[23] Yang SD, Zhu Y, Deng ZS, et al. Zhongguo Xiandai Yixue Zazhi. 2005;15(13):1962-1964.

杨慎达,朱勇,邓展生,等. 下胫腓联合钩栓的研制及其生物力学比较研究[J]. 中国现代医学杂志,2005,15(13):1962-1964.

[24] Tiemstra JD. Update on acute ankle sprains. Am Fam Physician. 2012;85(12):1170-1176.

[25] Rammelt S, Zwipp H, Grass R. Injuries to the distal tibiofibular syndesmosis: an evidence-based approach to acute and chronic lesions. Foot Ankle Clin. 2008;13(4):611-33, vii-viii.

[26] Norkus SA, Floyd RT. The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train. 2001;36(1):68-73.

[27] Beumer A, Valstar ER, Garling EH, et al. Effects of ligament sectioning on the kinematics of the distal tibiofibular syndesmosis: a radiostereometric study of 10 cadaveric specimens based on presumed trauma mechanisms with suggestions for treatment. Acta Orthop. 2006;77(3):531-540.

[28] Yu XH, Fang QS, Ji HQ. Treatment of trimalleolar fracture by fibular approach for exposing post malleolus. Zhongguo Gu Shang. 2009;22(2):138-139.

[29] Watson DJ, Weatherby BA, Womack JW. Dunking the knot in suture button fixation for distal tibiofibular syndesmosis injury: technique tip. Foot Ankle Int. 2012;33(8):686-688.

[30] Ebraheim NA, Lu J, Yang H, et al. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18(11):693-698.

[31] Elgafy H, Semaan H B, Blessinger B, et al. Computed tomography of normal distal tibiofibular syndesmosis. Skeletal Radiol. 2009;39(6):559-564.

[32] Gerber JP, Williams GN, Scoville C R, et al. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998; 19(10):653-660.

[33] Childs SG. Syndesmotic ankle sprain. Orthop Nurs. 2012; 31(3): 177-184.