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  • Title: Posterior translation of the fibula may indicate malreduction: CT study of normal variation in uninjured ankles.
    Author: Lepojärvi S, Pakarinen H, Savola O, Haapea M, Sequeiros RB, Niinimäki J.
    Journal: J Orthop Trauma; 2014 Apr; 28(4):205-9. PubMed ID: 23899768.
    Abstract:
    OBJECTIVES: The aim of our study was to assess the intersubject and intrasubject variations of distal tibiofibular syndesmosis on computed tomography (CT) scans and to define standardized measures to verify syndesmosis reduction. DESIGN: A retrospective study of 107 CT scans of ankles with normal tibiofibular syndesmosis. SETTING: Main trauma center, university teaching hospital. PATIENTS: The CT scans of 64 patients were reviewed by 2 musculoskeletal radiologists. MAIN OUTCOME MEASUREMENTS: Bilateral variation was estimated. The intra- and interobserver reliabilities were calculated using standardized measurement points. CT measurements included the length of the tibial incisura (LI), A width and P width of the incisura (PW), depth of the incisura, narrowest part of the incisura, and sagittal translation of the fibula. RESULTS: In 97% of normal cases, the fibula is situated either centrally or anteriorly in the tibial incisura. There were significant differences in PW and LI between genders, and the difference between the PW and A width was significantly larger in males (2.7 mm, SD 2.1) than in females (1.9 mm, SD 1.6, P = 0.023, t test). Significant asymmetry was not detected between ankles in single subjects. All CT measurements demonstrated good inter- and intraobserver reliabilities. CONCLUSIONS: If P translation of the fibula is present, malreduction should be considered. Sagittal translation measurements are not affected by the size of the joint or the gender of the patient, in contrast to traditionally used cross-sectional measurement methods.
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