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Category: Trauma Introduction/Purpose: Postoperative malreduction of syndesmotic disruptions in the rotational ankle fractures can make the poor functional outcome. There were many efforts to evaluate the quality of syndesmotic reduction with computed tomography (CT). However, there were few studies to show the acceptable range of syndesmotic reduction with CT. The aim of this study to investigate the reduction of the distal tibiofibular joint after open reduction and positional pinning with anterolateral approach in rotational ankle injuries and show acceptable range of syndesmotic reduction. Methods: This study included axial CT images of 104 patients (104 ankles) with rotational ankle fractures which were obtained in both ankles including uninjured ankle between 2012 February and 2014 June. At 10 mm proximal to the tibial plafond, anterior, middle, posterior shortest distances (aTFD, mTFD, pTFD) between fibula and tibia were measured and compared with those of uninjured ankles preoperatively, immediate postoperatively and at the followup after removal of syndesmotic fixation. The shortest distance from the anterior border of the fibula to the connecting line between most prominent point of anterior tibia and most prominent point of lateral fibula (ATF) were measured and compared in both ankles preoperatively, immediate postoperatively and at the followup after removal of syndesmotic fixation. The clinical outcomes were evaluated with AOFAS hindfoot score and visual analogue scale for pain. Results: Mean preoperative aTFD, mTFD, pTFD were 3.4±0.5 mm, 6.2±2.4 mm, 10.3±2.9 mm respectively. Mean immediate aTFD, mTFD, pTFD were 1.4±0.3 mm, 2.9±0.5 mm, 5.1±2.0 mm respectively. Mean postoperative aTFD, mTFD, pTFD at the followup after pin removal were 2.4±0.5 mm, 3.6±1.0 mm, 6.3±2.9 mm respectively. Mean ATF were 0.5±0.1 postoperatively. Both aTFD and mTFD significantly improved immediate postoperatively and at the followup after removal of syndesmotic fixation. However mean pTFD was widened compared to uninjured ankle. All postoperative clinical outcomes were improved significantly. Conclusion: Open reduction and positional pinning with anterolateral approach in rotational ankle injuries could show the good clinical outcomes and posterior tibiofibular diastasis could be allowed in terms of syndesmotic reduction if there is no anterior translation of fibula with improved anterior and middle tibiofibular distance at the axial CT images.

Serial CT Evaluation for the Reduction of the Distal Tibiofibular Joint after Open Reduction and Positional Pinning in Ankle Injuries