The use of intraoperative comparative fluoroscopy allows for assessing sagittal reduction and predicting syndesmosis reduction in ankle fractures

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dc.contributor.authorAbarca M.
dc.contributor.authorMora E.
dc.contributor.authorPalma J.
dc.contributor.authorBesa P.
dc.contributor.authorPalma J.
dc.contributor.authorLira M.J.
dc.contributor.authorAbarca M.
dc.contributor.authorFilippi J.
dc.contributor.authorFilippi J.
dc.date.accessioned2024-01-10T13:10:33Z
dc.date.available2024-01-10T13:10:33Z
dc.date.issued2021
dc.description.abstract© 2021 European Foot and Ankle SocietyIntraoperative fluoroscopic parameters have shown to be poor predictors for ankle syndesmosis reduction, with up to 52% of syndesmotic malreduction (SMR) reported in the literature. Anteroposterior Tibio-Fibular index (APTF) was previously described to evaluate sagittal tibiofibular alignment in lateral ankle radiographs with a high correlation between both ankles in uninjured subjects. Reproducible intraoperative measurements for sagittal syndesmotic reduction are lacking. We propose the use of the “cAPTF,” calculated as the absolute difference between the APTF of the non-injured and the operated ankle, to evaluate sagittal syndesmotic reduction. Objective: Determine the predictive capability of cAPTF for SMR. Method: Prospective observational study. Inclusion criteria: patients with unstable ankle fractures requiring syndesmotic fixation, with a healthy contralateral ankle. Intraoperatively APTF was measured in both ankles after syndesmotic fixation. Postoperatively cAPTF was calculated. Only direct syndesmosis visualization through the lateral approach and AP and mortise views were used by surgeons to assess syndesmotic reduction. Quality of syndesmotic reduction was evaluated with bilateral postoperative CT. To estimate cAPTF discriminatory power for SMR, a receiver operative characteristic (ROC) curve was obtained and the area under the ROC curve was calculated. Youden index was used to determine the ideal cAPTF cut-off value for predicting SMR. For this determined cut-off value, sensitivity, specificity, and likelihood ratio were calculated. Results: Fifty-two patients were included. Sixteen (30%) had SMR. Patients with SMR had a statistically significant higher cAPTF value than the well reduced (median 0.26 vs 0.09; P < 0.01). The cAPTF cut-off value to predict SMR was 0.161. A cAPTF greater than 0.161 had 100% sensitivity and 97,2% specificity for SMR. The area under the ROC curve was 0.99. Conclusion: Intraoperative cAPTF has excellent discriminatory power for predicting syndesmotic malreduction. We propose the routine use of intraoperative bilateral comparative fluoroscopy to assess sagittal syndesmotic reduction.
dc.fechaingreso.objetodigital22-03-2024
dc.fuente.origenScopus
dc.identifier.doi10.1016/j.fas.2021.10.003
dc.identifier.eissn14609584
dc.identifier.issn14609584 12687731
dc.identifier.scopusidSCOPUS_ID:85117411971
dc.identifier.urihttps://doi.org/10.1016/j.fas.2021.10.003
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/77881
dc.information.autorucFacultad de Medicina; Lira Salas, Maria Jesus; S/I; 195663
dc.language.isoen
dc.nota.accesocontenido parcial
dc.publisherElsevier Ltd
dc.relation.ispartofFoot and Ankle Surgery
dc.revistaFoot and Ankle Surgery
dc.rightsacceso restringido
dc.subjectAnkle fractures
dc.subjectComputed tomography
dc.subjectDiagnosis
dc.subjectRadiographs
dc.subjectReduction
dc.subjectSyndesmosis
dc.titleThe use of intraoperative comparative fluoroscopy allows for assessing sagittal reduction and predicting syndesmosis reduction in ankle fractures
dc.typeartículo
sipa.codpersvinculados195663
sipa.indexScopus
sipa.trazabilidadCarga SIPA;09-01-2024
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