Abstract：
OBJECTIVE: The objective of this study was to compare the quality of syndesmotic reduction with the ankle in maximal dorsiflexion versus neutral plantarflexion (normal resting position).
METHODS: Baseline computed tomography (CT) imaging of 10 cadaveric ankle specimens from 5 donors was obtained with the ankles placed in normal resting position. Two fellowship-trained orthopaedic surgeons disrupted the syndesmosis of each ankle specimen. All ankles were then placed in neutral plantarflexion and were subsequently reduced with thumb pressure under direct visualization through an anterolateral approach and stabilized with one 0.062-inch K-wire placed from lateral to medial in a quadricortical fashion across the syndesmosis. Postreduction CT scans were then obtained with the ankle in normal resting position. This process was repeated with the ankles placed in maximal dorsiflexion during reduction and stabilization. Postreduction CT scans were then obtained with the ankles placed in normal resting position. All postreduction CT scans were compared with baseline CT imaging using mixed-effects linear regression with significance set at P < 0.05.
RESULTS: Syndesmotic reduction and stabilization in maximal dorsiflexion led to increased external rotation of the fibula compared with baseline scans [13.0 ± 5.4 degrees (mean ± SD) vs. 7.5 ± 2.4 degrees, P = 0.002]. There was a tendency toward lateral translation of the fibula with the ankle reduced in maximal dorsiflexion (3.3 ± 1.0 vs. 2.7 ± 0.7 mm, P = 0.096). No other statistically significant differences between measurements of reduction with the ankle placed in neutral plantarflexion or maximal dorsiflexion compared with baseline were present (P > 0.05).
CONCLUSIONS: Reducing the syndesmosis with the ankle in maximal dorsiflexion may lead to malreduction with external rotation of the fibula. There was no statistically significant difference in reduction quality with the ankle placed in neutral plantarflexion compared with baseline. Future studies should assess the clinical implications of ankle positioning during syndesmotic fixation.
METHODS: Baseline computed tomography (CT) imaging of 10 cadaveric ankle specimens from 5 donors was obtained with the ankles placed in normal resting position. Two fellowship-trained orthopaedic surgeons disrupted the syndesmosis of each ankle specimen. All ankles were then placed in neutral plantarflexion and were subsequently reduced with thumb pressure under direct visualization through an anterolateral approach and stabilized with one 0.062-inch K-wire placed from lateral to medial in a quadricortical fashion across the syndesmosis. Postreduction CT scans were then obtained with the ankle in normal resting position. This process was repeated with the ankles placed in maximal dorsiflexion during reduction and stabilization. Postreduction CT scans were then obtained with the ankles placed in normal resting position. All postreduction CT scans were compared with baseline CT imaging using mixed-effects linear regression with significance set at P < 0.05.
RESULTS: Syndesmotic reduction and stabilization in maximal dorsiflexion led to increased external rotation of the fibula compared with baseline scans [13.0 ± 5.4 degrees (mean ± SD) vs. 7.5 ± 2.4 degrees, P = 0.002]. There was a tendency toward lateral translation of the fibula with the ankle reduced in maximal dorsiflexion (3.3 ± 1.0 vs. 2.7 ± 0.7 mm, P = 0.096). No other statistically significant differences between measurements of reduction with the ankle placed in neutral plantarflexion or maximal dorsiflexion compared with baseline were present (P > 0.05).
CONCLUSIONS: Reducing the syndesmosis with the ankle in maximal dorsiflexion may lead to malreduction with external rotation of the fibula. There was no statistically significant difference in reduction quality with the ankle placed in neutral plantarflexion compared with baseline. Future studies should assess the clinical implications of ankle positioning during syndesmotic fixation.
摘要：
目的：本研究的目的是比较踝关节最大背屈与中性足屈（正常静息位）的联合复位质量。
方法：对来自5个供体的10个尸体踝关节标本进行基线计算机断层扫描（CT）成像，踝关节置于正常静息位置。两名受过研究训练的骨科医生破坏了每个踝关节标本的结合。然后将所有脚踝置于中性的pi屈，随后通过前外侧入路在直接可视化的情况下用拇指压力降低，并用一根0.062英寸的K线从外侧到内侧以四向方式放置在整个韧带中。然后在踝关节处于正常静息位置的情况下进行复位后CT扫描。在复位和稳定期间，将脚踝置于最大背屈状态，重复此过程。然后将脚踝置于正常的静息位置进行复位后CT扫描。使用混合效应线性回归将所有复位后CT扫描与基线CT成像进行比较，显著性设置为P<0.05。
结果：与基线扫描相比，最大背屈联合减少和稳定导致腓骨外旋增加[13.0±5.4度（平均值±SD）与7.5±2.4度，P=0.002]。随着踝关节的最大背屈减少，腓骨有横向平移的趋势（3.3±1.0vs.2.7±0.7mm,P=0.096)。与基线相比，踝关节放置在中性足底屈或最大背屈的复位测量值之间没有其他统计学差异（P>0.05）。
结论：在最大背屈时减少踝关节联合可能会导致腓骨外旋畸形。与基线相比，踝关节处于中性足底弯曲的复位质量没有统计学上的显着差异。未来的研究应评估踝关节联合固定术中踝关节定位的临床意义。
方法：对来自5个供体的10个尸体踝关节标本进行基线计算机断层扫描（CT）成像，踝关节置于正常静息位置。两名受过研究训练的骨科医生破坏了每个踝关节标本的结合。然后将所有脚踝置于中性的pi屈，随后通过前外侧入路在直接可视化的情况下用拇指压力降低，并用一根0.062英寸的K线从外侧到内侧以四向方式放置在整个韧带中。然后在踝关节处于正常静息位置的情况下进行复位后CT扫描。在复位和稳定期间，将脚踝置于最大背屈状态，重复此过程。然后将脚踝置于正常的静息位置进行复位后CT扫描。使用混合效应线性回归将所有复位后CT扫描与基线CT成像进行比较，显著性设置为P<0.05。
结果：与基线扫描相比，最大背屈联合减少和稳定导致腓骨外旋增加[13.0±5.4度（平均值±SD）与7.5±2.4度，P=0.002]。随着踝关节的最大背屈减少，腓骨有横向平移的趋势（3.3±1.0vs.2.7±0.7mm,P=0.096)。与基线相比，踝关节放置在中性足底屈或最大背屈的复位测量值之间没有其他统计学差异（P>0.05）。
结论：在最大背屈时减少踝关节联合可能会导致腓骨外旋畸形。与基线相比，踝关节处于中性足底弯曲的复位质量没有统计学上的显着差异。未来的研究应评估踝关节联合固定术中踝关节定位的临床意义。
