Yüksel Uğur Yaradılmış1, Yusuf Polat1, Mehmet Baran Uslu1, Ahmet Ateş2, İsmail Demirkale2, Murat Altay2

1Department of Orthopaedics and Traumatology, Çankırı State Hospital, Çankırı, Turkey
2Department of Orthopaedics and Traumatology, University of Health Sciences, Keçiören Health Practice and Research Center, Ankara, Turkey

Keywords: Malreduction, overcompression, radiological diagnosis, syndesmosis injury


Objectives: This study aims to improve the diagnostic reliability of syndesmosis injuries through evaluation of radiological measurements in the Turkish population and to provide mean reference values to prevent malreduction and overcompression during the treatment.

Patients and methods: This retrospective study was performed between January 2018 and May 2018. The bilateral anteroposterior (AP) and lateral radiographs of 100 patients (60 males, 40 females; mean age 42.9 years; range, 23 to 72 years) who presented at our polyclinic were analyzed. Tibiofibular overlap (TFO), tibiofibular clear space (TFCS) and medial clear space (MCS) measurements were performed on the AP radiographs. The lateral radiographs were evaluated in respect of the anterior tibiofibular interval (ATFI), posterior tibiofibular interval (PTFI), and anterior tibiofibular ratio (ATFR) for syndesmosis reduction assessment. The lower and upper limits, mean and median values of the measurements were recorded.

Results: The measurements on the AP radiographs were determined to be as TFO: 7.9±2.4 mm (4-13), TFCS: 3.8±0.9 mm (2.2-6), MCS: 3.3±0.4 mm (2.7-4.5), and superior clear space: 3.3±0.3 mm (2.7-3.8). According to the measurements on the AP radiographs, the TFCS did not show any difference in terms of the variables of age, gender and side (p=0.070, p=0.219 and p=1.0, respectively). These measurements on the AP radiographs showed a high statistical consistency in terms of side (p=0.72, p=1.0, p=0.900 and p=0.920, respectively). The measurements on the lateral radiographs were as ATFI: 12.8±2.4 mm (8-18), PTFI: 6.1±2.9 mm (3-15) and ATFR: 0.4±0.1 (0.28-0.5). According to the measurements on the lateral radiographs, the ATFR did not show any difference in terms of the variables of age, gender and side (p=0.750, p=0.570 and p=0.848, respectively). The lateral measurements indicated statistical consistency in terms of side (p=0.400, p=0.260 and p=0.848, respectively).

Conclusion: On the AP radiographs, TFCS was found to be reliable and the intraoperative evaluation of its high consistency with the opposite extremity is appropriate to avoid overcompression. The evaluation of ATFR on lateral radiographs was found to be reliable and evaluation is recommended to avoid intraoperative malreduction.

Citation: Yaradılmış YU, Polat Y, Uslu MB, Ateş A, Demirkale İ, Altay M. The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: A regional study in Turkey. Jt Dis Relat Surg 2020;31(1):123-129.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.