Syndesmosis injury associated with high-energy tibial shaft fractures: Case series of a misdiagnosis rupture

S Carlucci; A Garcia-Mansilla; F Holc; G Carabelli; D Taype; C Sancineto; J D Barla

doi:10.1016/j.recot.2021.05.008

Syndesmosis injury associated with high-energy tibial shaft fractures: Case series of a misdiagnosis rupture

Rev Esp Cir Ortop Traumatol. 2022 Jul-Aug;66(4):274-280. doi: 10.1016/j.recot.2021.05.008. Epub 2021 Jul 31.

[Article in English, Spanish]

Authors

S Carlucci¹, A Garcia-Mansilla², F Holc¹, G Carabelli¹, D Taype¹, C Sancineto¹, J D Barla¹

Affiliations

¹ Unidad de Trauma Ortopédico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
² Unidad de Trauma Ortopédico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: garciamansillaagustin@gmail.com.

PMID: 34344620
DOI: 10.1016/j.recot.2021.05.008

Abstract

Introduction: Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures.

Methods: 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method.

Results: From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the sample, shown an increased talocrural angle in the postoperative radiographs, evidencing shortening of the fibula. Nine patients underwent surgery, the remaining patient was lost to follow-up. All the treated patients presented restoration of the normal talocrural angle.

Conclusion: The incidence of syndesmotic injuries associated with high-energy tibial shaft fractures reaches 4.27%. We think that is necessary to evaluate the ankle and syndesmosis in all tibial shaft fractures, even with high-energy patterns, not only in spiral patterns.

Keywords: Alta energía; Failure; Falla; Fractura de tibia; High energy; Sindesmosis; Syndesmosis; Tibial shaft fracture.