DETECTING FACTORS OF SYNDESMOTIC INJURY IN ANKLE FX. IN RADIOGRAPH
분당서울대학교병원 최 영
Ankle Fracture
Indrect ankle Fx. One of the most common injury on OS
Ankle Anatomy
Ankle Anatomy
Ankle Fracture
Lauge-Hansen Classification
Ankle Fracture
Lauge-Hansen Classification
Supination - External Rotation Supination Addution Pronation - External Rotation Pronation Addution
Ankle Fracture
Lauge-Hansen Classification
Supination - External Rotation Supination Adduction Pronation - External Rotation Pronation Addution
Ankle Fracture
Lauge-Hansen Classification
Supination - External Rotation Supination Addution Pronation - External Rotation Pronation Addution
Ankle Fracture
Lauge-Hansen Classification
Supination - External Rotation Supination Addution Pronation - External Rotation Pronation Addution
SER type
Syndesmosis injury
A syndesmosis is slightly movable articulation where the contiguous bony surfaces are united by an interosseous ligament or membrane as in the inferior tibiofibular articulation
Hypothesis
Bony attenuation vs Syndesmosis
Hypothesis
Bony attenuation vs Syndesmosis
Patients
Patents : ankle Fx. c OP in our hospital From Mar. 2006 to Feb. 2013 1109 cases
Inclusion SER type Preoperative X-ray, 3D-CT
Exclusion Direct injury, anatomical deformity Inadequate radiography
Measurement Method
3-Dimension CT X-ray (Mortise view)
Radiographic measurement
Fracture height Fracture length Medial joint space Bony attenuation
Fracture height
Medial joint space
Fracture length
Bony attenuation (Lat. Malleolus)
Bony attenuation (Med. Malleolus)
Bony attenuation (Talus)
Ankle Mortise view
Fracture height
Medial joint space
Statistical Method
median, interquatile range(IQR) and pro-portions
Kolmogogrov-Smirnov test Univariate analyses (Mann-Whitney U
test or chi-square exact test) receiver operating characteristic (ROC)
curve Delong’s test detect the significant of the area under the
curve (AUC)
Result
SER type ankle Fx. : total 191 patients
Male : Female = 104 : 87
Mean age = 53.2±15.2 years (range 18-
85)
Syndesmotic injury (+) : 38 patients
Syndesmotic injury (-) : 153 patients
Result : CT
Fracture height Syndesmotic injury (+) : 13.89±17.36 Syndesmotic injury (- ) : -0.87±6.95 P-value < 0.001
Medial joint spaces Syndesmotic injury (+) : 5.58±3.48 Syndesmotic injury (- ) : 3.41 ±1.55 P-value < 0.001
Result : CT
Medial joint spaces Syndesmotic injury (+) : 333.58±91.03 Syndesmotic injury (- ) : 244.67 ±94.69 P-value < 0.001
Fracture length Syndesmotic injury (+) : 37.45±13.57 Syndesmotic injury (- ) : 34.46 ±11.63 P-value =0.232
Result : CT
AUC : 0.765
Result : CT
AUC : 0.731
Result : CT
AUC : 0.753
Result : CT
Fracture height Syndesmotic injury (+) : 15.13 ±18.79 Syndesmotic injury (- ) : -1.28±7.22 P-value < 0.001
Medial joint spaces Syndesmotic injury (+) : 5.84±3.39 Syndesmotic injury (- ) : 3.34±1.49 P-value < 0.001
Result : CT
AUC : 0.569
Result : X-ray
AUC : 0.779
Result : X-ray
AUC : 0.726
Conclusion
SER type Ankle Fx. X-ray
frature height > 7mm Medial joint space > 4.5mm
CT Fracture height > 3mm Medial joint space > 4.9mm Bony attenuation > 262.7
Conclusion
Consideration of treatment on Ankle Fx.
Predictive Factors of Syndesmotic injury
Thank you for your atten-tion
Discussion
X-ray, CT Factors to detect syndesmotic injury
Limitation Retrospective study Technical problem in radiograph