Distal tibiofibular syndesmosis injury: How to determine the optimal position using CT scan during reconstruction？

Abstract

Abstract Distal tibiofibular syndesmosis (DTS) injuries account for 1–11% of all ankle injuries. The establishment of minimally invasive and precise treatment mode to repair the bone structure and soft tissue has been discussed in literature, but the optimal reconstruction for this unique clinical problem has not been determined. We retrospectively collected 517 CT images of tibia and fibula (289 males, 228 females, 270 right feet and 249 left feet). To set the ideal implant point cp through CT images first, and then measuring a series of parameters through point cp, including the maximum front and rear radial distance between the point cp, the distance between the axis, the distance from the medial and external ankle, and the distance from the tibia joint surface to the axis. Then we figure out the optimal implantation point through these parameters. On the cross section, the values of a. b. c. and β were 1.84 ± 1.24mm, 3.58 ± 1.62mm, 4.74 ± 1.93mm, 25.30 ± 14.70 °, respectively. On the coronal section, the values of d. e. f. g. h. were 2.94 ± 2.24mm, 1.35 ± 0.75mm, 3.18 ± 1.48mm, 1.93 ± 0.71mm, 2.93 ± 1.31mm, respectively. There are significant differences between gender (P < 0.05) and no significant difference in the left and right foot parameters (P > 0.05). The CT scan provided a feasible option of surgical bone tunnel reconstruction of combined DTS, where the surgeons could drill a tunnel with the angle of 20–25° from the Coronal and horizontal planes, with the distance of 1.84 ± 1.24mm (male) and 1.74 ± 1.00mm (female) from the ankle tip, with the diameter of 2.50mm (male) and 2.00mm (female). Because the parameters of female patients are lower than male patients, surgeons should be more cautious in surgery. Level of evidence Level IV, retrospective case series.