Abstract
Syndesmotic injuries are quite common, but accurate diagnosis and treatment can be
difficult, in part because of individual anatomic variation and complex movements
of the fibula in the incisura. The current cadaveric study was designed to investigate
changes in the position of the fibula in the incisura during simulated weightbearing
in different foot positions and with sequential sectioning of syndesmotic and deltoid
ligaments. Sixteen paired, fresh-frozen cadaveric limbs were embedded in polymethylmethacrylate
mid-calf and placed in a weightbearing simulation frame. Computed tomography scans
were obtained while the legs were in a simulated foot-flat position (75 N) and single-leg
stance (700 N) in 5 foot positions: neutral, 15° external rotation, 15° internal rotation,
20° dorsiflexion, and 20° plantar flexion. The anterior-inferior tibiofibular ligament,
posterior tibiofibular ligament complex, deltoid, and interosseous membranes were
sectioned sequentially and rescanned. Measurements of fibular diastasis, rotation,
anterior-posterior and medial-lateral translation, and fibular shortening were performed.
The most destructive state resulted in the largest displacement at the syndesmosis.
The degree of subluxation in all ligament states was dependent on the foot position.
External rotation created statistically significant displacement at all levels of
injury. There were no significant differences between sides of the same donor. Our
data demonstrate the importance of foot position in reduction at the syndesmosis under
weightbearing. The current ex vivo model could be used to evaluate other aspects of
this injury or the value of reconstructive techniques in the future.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: The authors were not compensated, and no other institutional subsidies, corporate affiliations, or funding sources supported this work, unless clearly documented and disclosed. This investigation was performed with the assistance of the AO Foundation via the AOTRAUMA Network (Grant No.: AR2014_02).
Conflict of Interest: None reported.
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