Syndesmotic reduction: What technique is most accurate?

Q2 Health Professions

Foot Pub Date : 2025-12-01 Epub Date: 2025-08-13 DOI:10.1016/j.foot.2025.102191

Calvin J. Rushing

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引用次数: 0

Abstract

The purpose of the present study was to assess the reliability of three syndesmotic reduction methods (Indirect clamp reduction, direct reduction with palpation of the incisura congruence, direct reduction with articular surface visualization) across various syndesmotic injury conditions (ventral disruption; AITFL, 2-ligament injury; AITFL/IOL, and 3-ligament injury; AITFL/IOL/PITFL) in an in-vitro model. It was hypothesized that indirect clamp reduction would be the least reliable method, with a higher mal-reduction rate. A cadaveric model of syndesmotic injury in eight through the knee specimens was employed. Sagittal plane translation following reduction was recorded using a digital caliper. Malreduction was defined as a difference of > 2 mm from the intact condition. Overall, direct reduction with articular surface visualization was the most accurate method, irrespective of the injury state across all specimens (p > 0.01). Direct reduction with palpation of the incisura was reliable for 2 and 3-ligament injury conditions (p = 0.518); while indirect clamp reduction was least reliable (p = 585). As the injury condition progressed, the incidence of malreduction increased for direct palpation, and clamp reduction. No malreductions were recorded using direct visualization of the articular surface. In the present cadaveric model, indirect clamp reduction was the least reliable method for syndesmotic realignment, with the highest incidence of malreduction. Surgeons should be cognizant of the inherent subjectivity, and limited reliability of the historically popularized clamp reduction method.

Level of Evidence

Level V, cadaveric

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联合复位：什么技术最准确？

本研究的目的是在体外模型中评估三种韧带联合复位方法（间接钳位复位、触诊切牙一致性直接复位、关节面可视化直接复位）在各种韧带联合损伤情况（腹侧断裂、AITFL、2韧带损伤、AITFL/IOL、3韧带损伤、AITFL/IOL/PITFL）下的可靠性。假设间接钳位复位是最不可靠的方法，有较高的误复位率。采用8个膝关节标本的骨联合损伤尸体模型。复位后矢状面平移用数字卡尺记录。复位不良定义为与完好状态差>； 2 mm。总体而言，无论所有标本的损伤状态如何，直接复位关节面可视化是最准确的方法（p >； 0.01）。触诊切牙直接复位治疗2、3韧带损伤是可靠的（p = 0.518）；而间接钳位复位最不可靠（p = 585）。随着损伤情况的进展，直接触诊和钳位复位不当的发生率增加。直接观察关节面无复位不良记录。在目前的尸体模型中，间接钳位复位是最不可靠的联合复位方法，复位不良的发生率最高。外科医生应该认识到固有的主观性，以及历史上流行的钳复位方法的有限可靠性。证据等级V级，尸体

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来源期刊

Foot Health Professions-Podiatry

CiteScore

2.00

自引率

0.00%

发文量

期刊介绍： The Foot is an international peer-reviewed journal covering all aspects of scientific approaches and medical and surgical treatment of the foot. The Foot aims to provide a multidisciplinary platform for all specialties involved in treating disorders of the foot. At present it is the only journal which provides this inter-disciplinary opportunity. Primary research papers cover a wide range of disorders of the foot and their treatment, including diabetes, vascular disease, neurological, dermatological and infectious conditions, sports injuries, biomechanics, bioengineering, orthoses and prostheses.