Dataset Information

Acute clinical evaluation for syndesmosis injury has high diagnostic value.

ABSTRACT:

Purpose

To determine the diagnostic value of injury history, physical examination, six syndesmosis tests and overall clinical suspicion for syndesmosis injury.

Methods

All athletes (> 18 yrs) with an acute ankle injury presenting within 7 days post-injury were assessed for eligibility. Acute ankle injuries were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Standardized injury history was recorded, and physical examination was performed by an Orthopaedic Surgeon or Sports Medicine Physician. Overall clinical suspicion was documented prior to MRI. Multivariate logistic regression was used to determine the association between independent predictors and syndesmosis injury.

Results

Between September 2016 and July 2019, a total of 150 acute ankle injuries were included. The median time from injury to acute clinical evaluation was 2 days (IQR 2). Prior to clinical evaluation, the median patient reported Visual Analog Scale for pain was 8/10 (IQR 2). Syndesmosis injury was present in 26 acute ankle injuries. An eversion mechanism of injury had a positive LR 3.47 (CI 95% 1.55-7.77). The squeeze tests had a positive LR of 2.20 (CI 95% 1.29-3.77) and a negative LR of 0.68 (CI 95% 0.48-0.98). Overall clinical suspicion had a sensitivity of 73% (CI 95% 52-88) and negative predictive value of 89% (CI 95% 78-95). Multivariate regression analyses demonstrated significant association for eversion mechanism of injury (OR 4.99; CI 95% 1.56-16.01) and a positive squeeze test (OR 3.25; CI 95% 1.24-8.51).

Conclusions

In an acute clinical setting with patients reporting high levels of ankle pain, a negative overall clinical suspicion reduces the probability of syndesmosis injury. Eversion mechanism of injury and a positive squeeze test are associated with higher odds of syndesmosis injury.

Level of evidence

Level III.

SUBMITTER: Baltes TPA

PROVIDER: S-EPMC9568458 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Publications

Acute clinical evaluation for syndesmosis injury has high diagnostic value.

Baltes Thomas P A TPA Al Sayrafi Omar O Arnáiz Javier J Al-Naimi Maryam R MR Geertsema Celeste C Geertsema Liesel L Holtzhausen Louis L D'Hooghe Pieter P Kerkhoffs Gino M M J GMMJ Tol Johannes L JL

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 20220504 11

<h4>Purpose</h4>To determine the diagnostic value of injury history, physical examination, six syndesmosis tests and overall clinical suspicion for syndesmosis injury.<h4>Methods</h4>All athletes (> 18 yrs) with an acute ankle injury presenting within 7 days post-injury were assessed for eligibility. Acute ankle injuries were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Standardized injury history was recorded, and physica ...[more]

PMID: 35508553

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Project description:ObjectiveThe objective of this study was to conduct a meta-analysis by synthesizing multiple literature sources to explore whether there are any differences between elastic fixation and rigid fixation in the treatment of acute tibiofibular syndesmosis injuries. The aim was to provide effective guidance for clinical treatment.MethodsWe conducted a comprehensive search across seven databases, including both Chinese and English, to include all studies related to the treatment of acute tibiofibular syndesmosis injuries with elastic fixation and rigid fixation published between January 1, 2013, and November 15, 2022. Following the PRISMA guidelines, we rigorously screened, assessed, and extracted data from the included studies. The outcome measures included AOFAS scores at 3, 6, and 12 months postoperatively; tibiofibular clear space (TBCS) and tibiofibular overlap distance (TBOL) at the early postoperative and 12-month follow-up; intraoperative blood loss; operative time; time to full weight-bearing postoperatively; and postoperative complications. Meta-analysis was performed using Review Manager 5.4.ResultsA total of 35 studies were included, comprising 16 randomized controlled trials and 19 retrospective cohort studies. The study population included 2120 cases, with 1044 cases in the elastic fixation group and 1076 cases in the rigid fixation group. The elastic fixation group had higher AOFAS scores at 3, 6, and 12 months postoperatively compared to the rigid fixation group. Although the elastic fixation group had a slightly larger TBCS than the rigid fixation group in the early postoperative period, the difference between the two groups became statistically insignificant at 12 months postoperatively. There was no statistically significant difference in TBOL between the two groups in the early postoperative period, but at 12 months, the elastic fixation group had a greater TBOL than the rigid fixation group. Additionally, the elastic fixation group had lower rates of postoperative local irritation, wound infection, and postoperative internal fixation loosening or rupture compared to the rigid fixation group. The rate of postoperative tibiofibular redislocation did not differ statistically between the two groups. The time to full weight-bearing was shorter in the elastic fixation group than in the rigid fixation group. Although the elastic fixation group had a slightly longer operative time, there was no statistically significant difference in intraoperative blood loss between the two groups.ConclusionCompared to rigid fixation, elastic fixation in the treatment of acute tibiofibular syndesmosis injuries offers several advantages, including better postoperative ankle joint function recovery, more precise anatomical reduction of the syndesmosis postoperatively, a lower incidence of postoperative complications, and shorter time to full weight-bearing postoperatively. These findings provide robust guidance for clinical treatment.

Project description:PurposeRecently, a new suture-button fixation device has emerged for the treatment of acute distal tibiofibular syndesmotic injuries and its use is rapidly increasing. The current systematic review was undertaken to compare the biomechanical properties, functional outcome, need for implant removal, and the complication rate of syndesmotic disruptions treated with a suture-button device with the current 'gold standard', i.e. the syndesmotic screw.MethodA literature search in the electronic databases of the Cochrane Library, EMbase, Pubmed Medline, and Google Scholar, between January 1st 2000 to December 1st 2011, was conducted to identify studies in which unstable ankle fractures with concomitant distal tibiofibular syndesmotic injury were treated with either a syndesmotic screw or a suture-button device.ResultsA total of six biomechanical studies, seven clinical full-text studies and four abstracts on the TightRope system, and 27 studies on syndesmotic screw or bolt fixation were identified. The AOFAS of 133 patients treated with TightRope was 89.1 points, with an average study follow-up of 19 months. The AOFAS score in studies with 253 patients treated with syndesmotic screws (metallic and absorbable) or bolts was 86.3 points, with an average study follow-up of 42 months. Two studies reported an earlier return to work in the TightRope group. Implant removal was reported in 22 (10%) of 220 patients treated with a TightRope (range, 0-25%), in the screw or bolt group the average was 51.9% of 866 patients (range, 5.8-100%).ConclusionThe TightRope system has a similar outcome compared with the syndesmotic screw or bolt fixation, but might lead to a quicker return to work. The rate of implant removal is lower than in the syndesmotic screw group. There is currently insufficient evidence on the long-term effects of the TightRope and more uniform outcome reporting is desirable. In addition, there is a need for studies on cost-effectiveness of the treatment of acute distal tibiofibular syndesmotic disruption treated with a suture-button device.

Dataset Information

Acute clinical evaluation for syndesmosis injury has high diagnostic value.

Purpose

Methods

Results

Conclusions

Level of evidence

Publications

Acute clinical evaluation for syndesmosis injury has high diagnostic value.

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