ORIGINAL ARTICLE
ARTHROSCOPIC ASSESSMENT OF DISTAL TIBIOFIBULAR SYNDESMOSIS INANKLE FRACTURES: PREVALENCE BY WEBER TYPE

UDK: 616.728.4-072.1:616.718.7-001.5

Todorov R.1, Kuzmanovska B.2

1UniversityClinicforSurgicalDiseases “St. NaumOhridski”,  Ss.CyrilandMethodius,UniversitySkopje, RepublicofNorthMacedonia
2UniversityClinic TOARILUC, Ss. CyrilandMethodiusUniversity, Faculty of Medicine, Skopje, RepublicofNorthMacedonia

Todorov  Ristohttps://orcid.org/0009-0008-2218-357X
Kuzmanovska Biljanahttps://orcid.org/0000-0002-4118-2010

Abstract

Introduction: Anklefracturesarecommoninjuries, butthetrueextentofdamagetothedistaltibiofibularsyndesmosisisoftenunderestimatedwhenonlyradiographsandstandardstresstestsareused. Arthroscopyoffers a directanddynamicviewofthesyndesmosisandmayuncoverinstabilitythatwouldotherwisebemissedindifferentDanis–Weberfracturetypes.

Material and methods: Thisretrospective-prospective, single-centerstudyincluded 64 adultswithunstableanklefracturestreatedwithroutineanklearthroscopy,followedbyopenreductionandinternalfixation. FractureswereclassifiedasWeber A, B,or C. Duringarthroscopy, thedistaltibiofibularsyndesmosiswasprobedunderlateralstressandcategorisedasstableorunstable. TheprevalenceofarthroscopicallyconfirmedsyndesmoticinstabilitywascalculatedforthewholecohortandforeachWebertype, andtheassociationbetweenWebertypeandinstabilitywastestedwiththechi‑squaretest.

Results: Our patientcohortconsistedof 16 Weber A, 29 Weber B,and 19 Weber C fractures. Syndesmoticinstabilityconfirmedarthroscopicallywasfoundin 23 of 64 patients (35.9%). Instabilitywaspresentin 1/16 Weber A (6.3%), 9/29 Weber B (31.0%),and 13/19 Weber C fractures (68.4%). TheprevalenceofinstabilityincreasedfromWeber A toWeber C, andtheassociationbetweenfracturetypeandarthroscopicinstabilitywasstatisticallysignificant (χ², p < 0.001).

Conclusions: Inthisseriesofunstableanklefractures, roughlyoneinthreepatientshadanunstabledistaltibiofibularsyndesmosisduringarthroscopictesting, withthehighestratesinWeber C andintermediateinWeber B fractures. Althoughuncommon, instabilitywasalsoseeninoneWeber A fracture, showingthatfibularfracturelevelalonedoesnotfullyexcludesyndesmoticinvolvement. Surgeonsshouldconsiderselectiveorroutinearthroscopicevaluationofthesyndesmosis, especiallyinWeber B and C injuries.

Keywords:anklefracture; arthroscopy; syndesmosis;tibiofibularjoint;Weberclassification.

References:

  1. Pereira H, Correia P, Andrade R, etal. Acutesyndesmoticinjuriesinanklefractures: fromdiagnosistotreatmentandcurrentconcepts. EFORT OpenRev. 2021;6(5):379–387.
  2. Dattani R, Patnaik S, Kantak A, Srikanth B, Selvan TP. Injuriestothetibiofibularsyndesmosis. J BoneJointSurgBr. 2008;90(4):405–410.
  3. Ogilvie-Harris DJ, Reed SC. Disruptionoftheanklesyndesmosis: diagnosisandtreatmentbyarthroscopicsurgery. Arthroscopy. 1994 Oct;10(5):561-8.
  1. vandenBekerom MPJ, Hogervorst M, Bolhuis HW. Diagnosingsyndesmoticinstabilityinanklefractures. World J Orthop. 2011;2(7):51–56.
  2. Wagener ML, Beumer A, Swierstra BA. Correlationbetweenradiologicalassessmentofacuteanklefracturesandsyndesmoticinjuryon MRI. SkeletalRadiol. 2011;40(5):619–627.
  3. Hermans JJ, Wentink N, Beumer A, Hop WC, Heijboer MP, Moonen AF, Ginai AZ. Correlationbetweenradiologicalassessmentofacuteanklefracturesandsyndesmoticinjuryon MRI. SkeletalRadiol. 2012 Jul;41(7):787-801. 
  4. Chun DI, Cho JH, Min TH, Park SY, Kim KH, Kim JH, etal. Diagnosticaccuracyofradiologicmethodsforanklesyndesmosisinjury: a systematicreviewandmeta-analysis. J ClinMed. 2019;8(7):968. doi:10.3390/jcm8070968
  5. Ebrahimzadeh MH, etal. Intraoperativediagnosisofsyndesmosisinjuriesinexternalrotationanklefractures. J OrthopTrauma. 2005;19(9):582–586.
  6. Weber C anklefractureswithtibiofibulardiastasis: syndesmosis-onlyversuscombinedfixation. J BoneJointSurgBr. 1996;78(6):856–860.
  7. Krähenbühl N, Tscholl PM, Sutter R, etal. Canweight-bearingcone-beam CT reliablydifferentiatebetweenstableandunstablesyndesmoticankleinjuries? ClinOrthopRelatRes. 2022;480(4):667–679.
  8. de-las-HerasRomero J, etal. Endoscopicdetectionofsyndesmosisdamagesinpatientswithanklefractures. HospPract. 2019;47(4):189–196.
  9. DelBuono A, Florio A, Bianchi A, Dwyer T, Maffulli N. Intraoperativeevaluationofdistaltibiofibularsyndesmoticjoint. J OrthopTraumaRehabil. 2013;17(2):68–74.
  10. Sin YH, Lui TH. Arthroscopicallyassistedreductionofsagittal-planedisruptionofdistaltibiofibularsyndesmosis. ArthroscTech. 2019;8(5):e521-e525. doi:10.1016/j.eats.2019.01.010
  11. Zhang P, Liang Y, He J, Fang Y, Chen P, Wang J. DiagnosisoftibiofibularsyndesmosisinstabilityinWebertype B malleolarfractures: a clinicalstudywithanklearthroscopy. Injury. 2020;51(7):1616–1623.
  12. vandenBekerom MPJ, Mutsaerts EL, vanDijk CN. SyndesmoticinstabilityinWeber B anklefractures: a clinicalevaluation. FootAnkleInt. 2007;28(11):1303–1308.
  13. Corte-Real N, Caetano J. Ankleandsyndesmosisinstability: consensusandcontroversies. EFORT OpenRev. 2021 Jun 28;6(6):420-431.
  14. Takao M, Ochi M, Naito K, Uchio Y, Matsusaki M, Oae K. Arthroscopicdiagnosisoftibiofibularsyndesmosisdisruption. Arthroscopy. 2001;17(8):836–843.