Ideal angle of syndesmotic screw fixation: A CT-based cross-sectional image analysis study |
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| Institution: | 1. Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea;2. Department of Orthopedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea;1. IEQ Clinica, Floor 3rd Office 3-4, 110 Street, Los Mangos Neighborhood, Valencia 2001, Venezuela;2. Valle de San Diego Medical Center, Floor 1st, Office: 18, Don Julio Centeno Avenue, El Morro 2 Neighborhood, San Diego District, Carabobo State, Venezuela;1. Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand;2. Section of Epidemiology and Biostatistics, University of Auckland, New Zealand;3. Waikato District Health Board, New Zealand;4. National Institute of Demography and Economic Analysis, University of Waikato, New Zealand;5. Midland Trauma System, Waikato District Health Board, New Zealand;1. Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road Pathumwan Bangkok 10330, Thailand;2. Department of Anatomy, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road Pathumwan, Bangkok 10330, Thailand;1. Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital Affiliate to Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. Shanghai Sixth People’s Hospital Affiliate to Shanghai Jiao Tong University School of Medicine, Shanghai, China |
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| Abstract: | Without clear reference, the precision of syndesmotic screw placement cannot be guaranteed and malposition of these screws leads to poor results. Therefore, to prevent malpositioning of syndesmotic screws, an improved understanding of the orientation of tibiofibular syndesmosis is essential. We analyzed cross-sectional computed tomography (CT) scans of the foot and ankle to identify precise screw positions for the treatment of syndesmotic injuries. A total of 134 calcaneal fractures with intact tibiofibular syndesmosis were enrolled in this retrospective study. We measured the angle between the perpendicular line of the second proximal phalanx and the line start apex of the lateral cortex of the fibula bisecting the tibial incisura and crossing the center of the tibia in neutral ankle joints, with the second toe positioned anteriorly using a short leg splint. The second toe was used as the reference for clarity and applicability. The ideal angle of syndesmotic screw placement in cross-sectional CT images was 18.8 ± 5.6° (mean ± standard deviation) and did not differ according to independent variables (P > 0.05). In neutral ankle joints with the second toe positioned anteriorly, the ideal angle of syndesmotic screw placement is 18.8°, which is less than that currently in used in conventional methods. |
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| Keywords: | Ankle syndesmosis Computed tomography Ideal angle Syndesmotic screw fixation |
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