Comparison of 2 different methods to evaluate the ankle syndesmosis on lateral radiographs

12^th International Conference on ORTHOPEDICS, OSTEOPOROSIS & TRAUMA

November 13-14, 2019 | London, UK

Atul Kamat

West Hertfordshire Hospitals NHS Trust, UK

ScientificTracks Abstracts: J Orthop Trauma Surg Rel Res

Abstract :

Introduction: Ankle fractures with syndesmotic injuries treated surgically have a high rate of syndesmotic malreduction, up to 52% in some series. Plain radiography may be misleading and intra operative imaging may not be accurate. Several methods have been described for assessment of the syndesmosis on ankle lateral radiographs. We compare 2 methods in our study.

Aims: 1. To compare 2 different methods of assessing the integrity of the ankle syndesmosis on lateral radiographs- the Anteroposterior Tibiofibular Ratio (APTF) described by Grenier et al 2013 and Anterior Tibiofibular Ratio (ATFR) described by Croft et al 2015.

2. To validate the above methods of assessing the syndesmosis in our series.

Study design: Retrospective review of notes and radiographs

Method: 200 ankle lateral radiographs from patients presenting to our A/E with suspected ankle injuries studied by 2 authors together in agreement. ATFR and APTFR calculated. Any patient who needed syndesmotic fixation was considered as having sustained a true syndesmotic injury.

Results: APTF: 20 patients had normal syndesmotic values, 4 of whom underwent surgical fixation of the syndesmosis (20%). 93 patients had abnormal values, of whom 29 patients needed syndesmotic fixation (31%)

ATFR: 40 patients had normal syndesmotic values, of whom 10 underwent surgical fixation (25%). 73 patients had abnormal syndesmotic values, of whom 23 needed surgical fixation (31.5%)

Discussion: Assessment of the syndesmosis on lateral radiographs is not a commonly used technique in clinical practice. Several authors have attempted to describe radiological measurement techniques on the lateral radiograph including Summers Grenier Croft and Park. Grenier and Croft excluded ankle fractures in their reported series of patients. In our study we have attempted to assess the syndesmosis in all patients who presented with ankle injuries, including fractures. The low rate of diagnosis using these measurements makes both techniques unsuitable for routine clinical use.

Conclusion: The presence of displaced bony landmarks in a fractured ankle alters the measurements and hence the calculated values of APTF and ATFR are not reliable in the presence of displaced ankle fractures. Both techniques have a low rate of diagnosis in the presence of ankle fractures and hence cannot be used in routine clinical practice for the diagnosis of syndesmotic disruption.

Biography :

Atul Kamat currently working at The West Hertfordshire Hospitals NHS Trust in Trauma and Orthopedic Surgery Department. He has more than fifteen years of experience in Trauma & Orthopedic Surgery. He joined Goa Medical College and completed MBBS during this time I developed an interest in Trauma and Orthopedic Surgery. He decided to come to the United Kingdom to continue my pursuit and passed the PLAB examination. He has been working in the National Health Service has been a very satisfying experience and this has helped to gain valuable experience of working in a very diverse culture.

E-mail: atulcamat@yahoo.com