OTA 2005 Posters

Scientific Poster #88 Foot & Ankle

Intraoperative Three Dimensional Control after Closed Reduction and Internal Fixation of Maisoneuve Injuries

Tobias Hüfner, MD; M. Richter, MD; D. Kendoff, MD; M. Citak, MD;

T. Gösling, MD; Christian Krettek, MD (n-all authors);

Department Traumatology, Hannover Medical School, Hannover, Germany

Introduction: Closed reduction and internal screw fixation of Maisoneuve injuries is a standard procedure. As the fibular length can be controlled on fluoroscopy images, the crucial intraoperative control of fibular rotation is problematic with a conventional c-arm. Intraoperative three-dimensional reduction control of the fibula can be done accurately and an open procedure is not required.

Methods: A prospective case series with 12 patients (7 left, 5 right) was conducted. The inclusion criterion was acute closed Maisoneuve injury. Operation was done in a supine position. Three surgeons were involved in the study. Using the two-dimensional mode of the Iso C3D® (Siemens Inc, Erlangen, Germany), the fracture was reduced with a clamp and a 3.5-mm cortical screw was inserted transfibular and transtibial 3 cm proximal of the syndesmosis. Then an intraoperative three-dimensional Iso C3D scan was performed with the ankle in 90° position. At the workstation the reduction (° rotation) in the distal fibulotibial joint was analyzed. Anatomic reduction was defined as a rotation <1°.

Results: A primary anatomic reduction regarding rotation and length was achieved in 8 of 12 patients (75%). In the remaining four patients, the fibula was rotated 4.2° (range, 1° to 6°) externally, in no patient internally in relation to the tibia. The screw was removed, closed reduction was repeated, and the screw was inserted in a new position. Another Iso C3D scan was performed. In 3 of 4 patients the reduction was anatomic. In one patient the fibula was still derotated (3.5°). After revision, interposition of the posterior syndesmosis was identified as the problem. No patient developed an infection. The patients were mobilized with partial weight bearing. After 6 weeks the screw was removed and full weight bearing commenced. AOFAS score after 3.5 months (range, 3 to 6 months) was 88 (range, 78 to 92).

Conclusion/Significance: Intraoperative three-dimensional reduction control in the distal tibiofibular joint gives accurate information for decision making. Either the closed procedure can be continued, repeated, or an open procedure is required.