Detecting factors of Syndesmotic injury in Ankle Fx . in radiograph

DETECTING FACTORS OF SYNDESMOTIC IN-JURY IN ANKLE FX. IN RADIOGRAPH

분당서울대학교병원 최 영

Ankle Fracture Indrect ankle Fx.

One of the most common injury on OS

Ankle Anatomy

Ankle Anatomy

Ankle Fracture Lauge-Hansen Classification

Ankle Fracture Lauge-Hansen Classification

Supination - External Rotation Supination Addution Pronation - External Rotation Pronation Addution

Ankle Fracture Lauge-Hansen Classification

Supination - External Rotation Supination Adduction Pronation - External Rotation Pronation Addution

Ankle Fracture Lauge-Hansen Classification

Supination - External Rotation Supination Addution Pronation - External Rotation Pronation Addution

Ankle Fracture Lauge-Hansen Classification

Supination - External Rotation Supination Addution Pronation - External Rotation Pronation Addution

SER type

Syndesmosis injury

A syndesmosis is slightly movable articulation where the contiguous bony surfaces are united by an interosseous ligament or membrane as in the inferior tibiofibular articulation

Hypothesis Bony attenuation vs Syndesmosis

Hypothesis Bony attenuation vs Syndesmosis

Patients Patents : ankle Fx. c OP in our hospital

From Mar. 2006 to Feb. 2013 1109 cases

Inclusion SER type Preoperative X-ray, 3D-CT

Exclusion Direct injury, anatomical deformity Inadequate radiography

Measurement Method 3-Dimension CT X-ray (Mortise view)

Radiographic measurement Fracture height Fracture length Medial joint space Bony attenuation

Fracture height

Medial joint space

Fracture length

Bony attenuation (Lat. Malleolus)

Bony attenuation (Med. Malleolus)

Bony attenuation (Talus)

Ankle Mortise view

Fracture height

Medial joint space

Statistical Method median, interquatile range(IQR) and pro-

portions Kolmogogrov-Smirnov test Univariate analyses (Mann-Whitney U

test or chi-square exact test) receiver operating characteristic (ROC)

curve Delong’s test detect the significant of the area under the

curve (AUC)

Result

SER type ankle Fx. : total 191 patients Male : Female = 104 : 87 Mean age = 53.2±15.2 years (range 18-

85) Syndesmotic injury (+) : 38 patients Syndesmotic injury (-) : 153 patients

Result : CT Fracture height

Syndesmotic injury (+) : 13.89±17.36 Syndesmotic injury (- ) : -0.87±6.95 P-value < 0.001

Medial joint spaces Syndesmotic injury (+) : 5.58±3.48 Syndesmotic injury (- ) : 3.41 ±1.55 P-value < 0.001

Result : CT Medial joint spaces

Syndesmotic injury (+) : 333.58±91.03 Syndesmotic injury (- ) : 244.67 ±94.69 P-value < 0.001

Fracture length Syndesmotic injury (+) : 37.45±13.57 Syndesmotic injury (- ) : 34.46 ±11.63 P-value =0.232

Result : CT

AUC : 0.765

Result : CT

AUC : 0.731

Result : CT

AUC : 0.753

Result : CT Fracture height

Syndesmotic injury (+) : 15.13 ±18.79 Syndesmotic injury (- ) : -1.28±7.22 P-value < 0.001

Medial joint spaces Syndesmotic injury (+) : 5.84±3.39 Syndesmotic injury (- ) : 3.34±1.49 P-value < 0.001

Result : CT

AUC : 0.569

Result : X-ray

AUC : 0.779

Result : X-ray

AUC : 0.726

Conclusion SER type Ankle Fx. X-ray

frature height > 7mm Medial joint space > 4.5mm

CT Fracture height > 3mm Medial joint space > 4.9mm Bony attenuation > 262.7

Conclusion Consideration of treatment on Ankle Fx.

Predictive Factors of Syndesmotic injury

Thank you for your atten-tion

Discussion X-ray, CT

Factors to detect syndesmotic injury Limitation

Retrospective study Technical problem in radiograph