대한족부족관절학회지 (Journal of Korean Foot and Ankle Society)

  • 제17권4호
  • /
  • Pages.264-271
  • /
  • 2013
  • /
  • 1738-3757(pISSN)
  • /
  • 2288-8551(eISSN)
대한족부족관절학회 (Korean Foot & Ankle Society)
권호 표지

원위 경비 인대 결합 고정 긴장도와 기간이 나사못 제거 후 이개 및 임상 증상에 미치는 영향

The Impacts of Fixation Tightness and Duration on the Remnant Syndesmotic Widening and Clinical Symptom after Removal of Screws

  • 배서영 (인제대학교 의과대학 상계백병원 정형외과학교실) ;
  • 손수인 (인제대학교 의과대학 상계백병원 정형외과학교실) ;
  • 성민규 (인제대학교 의과대학 상계백병원 정형외과학교실)
  • Bae, Su-Young (Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University) ;
  • Sohn, Su-Een (Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University) ;
  • Seong, Min-Kyu (Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University)
  • 투고 : 2013.07.14
  • 심사 : 2013.11.12
  • 발행 : 2013.12.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: We aimed to analyze the effect of fixation tightness of the syndesmotic screw and its indwelling period on the recurrence of the syndesmosis widening after screw removal and the clinical outcomes. Materials and Methods: Forty consecutive patients with acute syndesmotic injury were retrospectively reviewed. The tibiofibular clear space is measured by digitalized measurement tool on serial radiographs. We analyzed the effect of time from trauma to fixation, syndesmotic screw indwelling duration, and fixation methods. Residual symptoms at the last follow up were evaluated. The student t-test, correlation test, and chi-square test were used for statistical analysis. Results: Eighteen ankles (45%) had recurrent syndesmosis widening (greater than 5% compared to the contralateral side). Seven patients had pain and five had limitation of motion in the ankle joint. Fixation tightness had significant effect on reducing the recurrence while the severity of the initial widening, time to fixation, and duration of fixation did not affect the outcome. Conclusion: Tight fixation of syndesmotic screw is essential for achieving final syndesmotic stability and reducing recurrence.

키워드

참고문헌

  1. Lee GB. Ankle syndesmotic injury. J Korean Fract Soc. 2007;20:282-90. https://doi.org/10.12671/jkfs.2007.20.3.282
  2. Miller AN, Paul O, Boraiah S, Parker RJ, Helfet DL, Lorich DG. Functional outcomes after syndesmotic screw fixation and removal. J Orthop Trauma. 2010;24:12-6. https://doi.org/10.1097/BOT.0b013e3181c6e199
  3. Ramsey P, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am. 1976;58:356-7. https://doi.org/10.2106/00004623-197658030-00010
  4. Dattani R, Patnaik S, Kantak A, Srikanth B, Selvan TP. Injuries to the tibiofibular syndesmosis. J Bone Joint Surg Br. 2008;90:405-10.
  5. Hoiness P, Stromsoe K. Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomized study comparing two methods of syndesmosis fixation. J Orthop Trauma. 2004;18:331-7. https://doi.org/10.1097/00005131-200407000-00001
  6. Kukreti S, Faraj A, Miles JN. Does position of syndesmotic screw affect functional and radiological outcome in ankle fractures? Injury. 2005;36:1121-4. https://doi.org/10.1016/j.injury.2005.01.014
  7. Manjoo A, Sanders DW, Tieszer C, MacLeod MD. Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal. J Am J Orthop Trauma. 2010;15:330-9.
  8. McBryde A, Chiasson B, Wilhelm A, Donovan F, Ray T, Bacilla P. Syndesmotic screw placement: a biomechanical analysis. Foot Ankle Int. 1997;18:262-6. https://doi.org/10.1177/107110079701800503
  9. Miller RS, Weinhold PS, Dahners LE. Comparison of tricortical screw flxation versus a modifled suture construct for flxation of ankle syndesmosis injury: a biomechanical study. J orthop Trauma. 1999;13:39-42. https://doi.org/10.1097/00005131-199901000-00009
  10. Stuart K, Panchbhavi VK. The fate of syndesmotic screws. J Am J Orthop Trauma. 2011;15:330-9.
  11. Bae SY, Chung HJ, Oh SC. Evaluation of intraoperative stress radiologic tests for syndesmotic injuries. J Korean Foot Ankle Soc. 2011;15:22-6.
  12. Boden SD, Labropoulos PA, McCowin P, Lestini WF, Hurwitz SR. Mechanical considerations for the syndesmosis screw. A cadaver study. J Bone Joint Surg Am. 1990;10: 325-30.
  13. Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. 1990;10: 325-30. https://doi.org/10.1177/107110079001000607
  14. Clarke HJ, Michelson JD, Cox QG, Jinnah RH. Tibiotalar stability in bimalleolar ankle fractures: a dynamic in vitro contact area study. Foot Ankle Int.1991;11:222-7. https://doi.org/10.1177/107110079101100407
  15. Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am. 1956;8A:761-81.
  16. Park SY, Park SW, Hahn SB, Jung WK, Choi KS, Lee SH. Syndesmosis injury associated with the Weber type B lateral malleolar fracture. J Korean Orthop Assoc. 2008;43: 359-65. https://doi.org/10.4055/jkoa.2008.43.3.359
  17. Rasmussen O, Tovborg-Jensen I, Boe S. Distal tibiofibular ligaments. Analysis of function. Acta Orthop Scand. 1990;10: 325-30.
  18. Gwak HC, Kwon YW. Ankle syndesmotic injury. J Korean Soc Foot Surg. 2011;15:187-94.
  19. Jordan TH, Talarico RH, Schuberth JM. The radiographic fate of the syndesmosis after trans-syndesmotic screw removal in displaced ankle fractures. J Foot Ankle Surg. 2011;15: 330-9.
  20. Needleman RL, Skrade DA, Stiehl JB. Effect of the syndesmotic screw on ankle motion. Foot Ankle. 1989:10;17-24. https://doi.org/10.1177/107110078901000104
  21. Tornetta P, Spoo JE, Reynolds FA, Lee C. Overtightening of the ankle syndesmosis: is it really possible? J Bone Joint Surg Am. 2001;83:492-7.
  22. Zalavras C and Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007;15:330-9. https://doi.org/10.5435/00124635-200706000-00002
  23. Lee DY. Comparative analysis for syndesmotic fixation vs non-syndesmotic fixation of distal tibiofibular diastasis. J Korean Fract Soc. 1998;11:585-90. https://doi.org/10.12671/jksf.1998.11.3.585
  24. Park HK, Moon SS. Ideal insertion position of ankle syndesmosis screw. J Korean Soc Foot Surg. 2002;6:60-5.