Syndesmotic Loose Bodies in Complex Ankle Fractures: Classification System
Introduction: Trimalleolar and quadrimalleolar fractures have a worse prognosis than other ankle fractures and are frequently associated with other injuries. Anatomic reduction of the fracture and the inferior tibiofibular joint is crucial to restore joint function; anyway, 4% of syndesmoses may bec...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Jaypee Brothers Medical Publisher
2025-06-01
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| Series: | Journal of Foot and Ankle Surgery (Asia Pacific) |
| Subjects: | |
| Online Access: | https://www.jfasap.com/doi/JFASAP/pdf/10.5005/jp-journals-10040-1400 |
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| Summary: | Introduction: Trimalleolar and quadrimalleolar fractures have a worse prognosis than other ankle fractures and are frequently associated with other injuries. Anatomic reduction of the fracture and the inferior tibiofibular joint is crucial to restore joint function; anyway, 4% of syndesmoses may become unstable. Loose bodies associated with these fractures may cause poor reductions and compromise joint mechanics.
The aim of this study is to classify syndesmotic loose bodies according to their location and to explore the relationship that exists according to the type of fracture.
Materials and methods: We conducted a retrospective study of 82 ankle fractures with syndesmotic loose bodies treated between 2006 and 2024. Computed tomography (CT) scans and X-rays were performed. Ankle fractures were classified according to Webber/AO, and posterior malleolar fragments according to Haraguchi and Bartoníček/Rammelt. Syndesmotic loose bodies were classified into four types according to the syndesmotic region they occupied on CT scans.
Results: About 26 patients were male and 56 were female, mean age was 59.1 years. We found 73 B3 and 9 C3 fractures. Type I loose bodies were found in 22 patients (27%), type II in 35 patients (43%), type III in 13 patients (15%), and in multiple areas, type IV in 12 patients (15%).
Conclusion: Tomographic classification system of syndesmotic loose bodies is useful for recognizing and locating intrasyndesmotic loose bodies.
Type II loose bodies were the most frequently found (43%) and were mainly associated with B3 fractures and Haraguchi type I and Bartoníček/Rammelt type II fragments.
Clinical significance: This study highlights the importance of recognizing and classifying syndesmotic loose bodies as essential steps when aiming for an accurate resolution. Level of evidence IV. |
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| ISSN: | 2348-280X 2394-7705 |