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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| Format: | Article |
| Language: | English |
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Jaypee Brothers Medical Publisher
2025-06-01
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| Series: | Journal of Foot and Ankle Surgery (Asia Pacific) |
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| Online Access: | https://www.jfasap.com/doi/JFASAP/pdf/10.5005/jp-journals-10040-1400 |
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| author | Hernán E Coria Daniela Blanco Héctor J Masaragian Luciano Mizdraji Fernando D Perin Leonel Rega Mauricio Rodriguez Acuña Johann Veizaga Velasco |
| author_facet | Hernán E Coria Daniela Blanco Héctor J Masaragian Luciano Mizdraji Fernando D Perin Leonel Rega Mauricio Rodriguez Acuña Johann Veizaga Velasco |
| author_sort | Hernán E Coria |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8a9429d86ff446c9862ad2c3cd70ef1f |
| institution | Kabale University |
| issn | 2348-280X 2394-7705 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Jaypee Brothers Medical Publisher |
| record_format | Article |
| series | Journal of Foot and Ankle Surgery (Asia Pacific) |
| spelling | doaj-art-8a9429d86ff446c9862ad2c3cd70ef1f2025-08-20T04:02:27ZengJaypee Brothers Medical PublisherJournal of Foot and Ankle Surgery (Asia Pacific)2348-280X2394-77052025-06-0112311611910.5005/jp-journals-10040-14003Syndesmotic Loose Bodies in Complex Ankle Fractures: Classification SystemHernán E Coria0https://orcid.org/0000-0002-0532-4763Daniela Blanco1https://orcid.org/0009-0006-0490-4295Héctor J Masaragian2https://orcid.org/0000-0001-5971-5121Luciano Mizdraji3Fernando D Perin4https://orcid.org/0000-0001-7921-7576Leonel Rega5https://orcid.org/0000-0002-6850-5318Mauricio Rodriguez Acuña6https://orcid.org/0009-0000-6000-7667Johann Veizaga Velasco7https://orcid.org/0000-0002-4998-2944Hernan E Coria, Department of Orthopedic Surgery, Foot and Ankle Surgery Section, Hospital Militar Central, Buenos Aires, Argentina, Phone: 541134746957Equipo Cirugía del Pie, Clínica Bazterrica, Buenos Aires, ArgentinaEquipo Cirugía del Pie, Clínica Bazterrica, Buenos Aires, ArgentinaEquipo Cirugía del Pie, Clínica Bazterrica, Buenos Aires, ArgentinaEquipo Cirugía del Pie, Clínica Bazterrica, Buenos Aires, ArgentinaEquipo Cirugía del Pie, Clínica Bazterrica, Buenos Aires, ArgentinaEquipo Cirugía del Pie, Clínica Bazterrica, Buenos Aires, ArgentinaEquipo Cirugía del Pie, Clínica Bazterrica, Buenos Aires, ArgentinaIntroduction: 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.https://www.jfasap.com/doi/JFASAP/pdf/10.5005/jp-journals-10040-1400ankle fracturesclassificationjoint loose bodyposterior malleolar fracturequadrimalleolar fracturesyndesmotic injurytrimalleolar fracture |
| spellingShingle | Hernán E Coria Daniela Blanco Héctor J Masaragian Luciano Mizdraji Fernando D Perin Leonel Rega Mauricio Rodriguez Acuña Johann Veizaga Velasco Syndesmotic Loose Bodies in Complex Ankle Fractures: Classification System Journal of Foot and Ankle Surgery (Asia Pacific) ankle fractures classification joint loose body posterior malleolar fracture quadrimalleolar fracture syndesmotic injury trimalleolar fracture |
| title | Syndesmotic Loose Bodies in Complex Ankle Fractures: Classification System |
| title_full | Syndesmotic Loose Bodies in Complex Ankle Fractures: Classification System |
| title_fullStr | Syndesmotic Loose Bodies in Complex Ankle Fractures: Classification System |
| title_full_unstemmed | Syndesmotic Loose Bodies in Complex Ankle Fractures: Classification System |
| title_short | Syndesmotic Loose Bodies in Complex Ankle Fractures: Classification System |
| title_sort | syndesmotic loose bodies in complex ankle fractures classification system |
| topic | ankle fractures classification joint loose body posterior malleolar fracture quadrimalleolar fracture syndesmotic injury trimalleolar fracture |
| url | https://www.jfasap.com/doi/JFASAP/pdf/10.5005/jp-journals-10040-1400 |
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