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Clamping along the transsyndesmotic (TS) axis decreases the risk of malreduction when reducing syndesmotic diastasis. We aimed to measure the difference between the TS axis and the axis determined by the newly proposed fluoroscopic incisura tangent (IT) method. The measurements were compared to those between the TS axis and those based on the center–center (CC) and talar dome lateral (TL) methods. We analyzed computed tomographic images of 43 normal ankles. The IT view was simulated using a digitally reconstructed radiograph, in which the anterior and posterior fibular incisura tubercles overlapped on the internally rotated anteroposterior view. The interaxis angle between the TS and the axes determined by the IT method was measured on the axial computed tomographic image corresponding to the radiographic image. The same procedure was repeated using the CC and TL methods. The measured values were compared between the three methods using a one-factor analysis of variance. Furthermore, the measurements of the anteverted and retroverted incisurae were compared for each fluoroscopic method. The mean interaxis angles between the TS were − 0.5 degrees, 6.3 degrees, and − 1.8 degrees for the IT, CC, and TL methods, respectively, with a significantly larger value for the CC method than for the IT and TL methods (P <.001). No significant difference was found in the interaxis angle in the anteverted (−0.1 degrees) and retroverted (−1.0 degrees) incisurae when using the IT method (P =.15). The angles in the retroverted incisurae were larger than those of the anteverted incisurae for the CC and TL methods. The fluoroscopic IT method accurately estimated the TS axis. The interaxis angles were consistent, regardless of the incisura anatomy. The fluoroscopic method can be used to clamp and fix the syndesmosis along the TS axis. Ⅳ [Display omitted] • Incisura tangent view is an internally rotated fluoroscopic image of the ankle. • The anterior and posterior tubercles of the fibular incisura overlap in this view. • The fluoroscopic method accurately estimates the transsyndesmotic axis. • It can reduce the risk of syndesmotic malreduction in ankle fracture surgery. [ABSTRACT FROM AUTHOR]

There is still no general agreement about the most effective form of syndesmosis fixation with syndesmotic screws for patients affected by ankle fractures that are accompanied by syndesmotic injuries. In the same manner, no consensus has been reached yet on whether or not the tibiofibular syndesmotic screw is more beneficial if removed or not, as well as the exact timing of removal if this proves superiority. The purpose of this research was to verify whether or not removing syndesmotic screws reduces the risk of developing a diastasis and compare outcomes in patients whose syndesmotic screw was or was not removed at all. A retrospective observational study was carried out to cover a period of five years and a computed sample size of almost 300 cases. Patients were included in the current study if their history was positive for ankle fracture with distal tibiofibular diastasis repair with syndesmotic screws. Loss of reduction was more frequent after screw removal (8.5% vs. 2.1%), although the quality of reduction was generally excellent in both groups. The mean AOFAS score was significantly better in patients who had their tibiofibular screw removed (92.6 vs. 88.4), but the tibiofibular clear space and incisura fibularis depth widened more following the second intervention (3.8 mm vs. 3.6 mm, and, respectively, 4.3 vs. 4.1). Lastly, the same patients with tibiofibular screw removal had a significantly higher cost of total interventions and more days of medical leave (21 vs. 15 days on average). It seems that a strong conclusion in favor of removing or not removing syndesmotic screws after distal tibiofibular diastasis repair cannot be given. However, several radiographic findings lean toward the benefit of those patients whose tibiofibular screws were not removed, although mobility was notably better after the screw was removed. Furthermore, treatment expenses are greatly lowered if a subsequent operation for screw removal is avoided, as well as if individuals who have a single surgery take a shorter medical leave. [ABSTRACT FROM AUTHOR]

Abstract: Pure tibiotalar dislocations without associated fracture are rare. The authors report a case of an unusual closed tibiotalar dislocation without fracture, involving proximal ascension of the talus. Despite immediate closed reduction, a tibiofibular diastasis remained, therefore two syndesmosis screws were inserted, followed by six weeks of plaster casting. After 5 years of follow-up, functional results were excellent, MRI showed slight arthritic degenerative changes. [Copyright &y& Elsevier]