The Evaluation of Radiological Measurements Used in Diagnosis and Treatment of Syndesmosis Injury: A Regional Study in Turkey

Abstract

Objectives: This study aims to improve the diagnostic reliabilityof syndesmosis injuries through evaluation of radiologicalmeasurements in the Turkish population and to provide meanreference values to prevent malreduction and overcompressionduring the treatment.Patients and methods: This retrospective study was performedbetween 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 ourpolyclinic were analyzed. Tibiofibular overlap (TFO), tibiofibularclear space (TFCS) and medial clear space (MCS) measurementswere performed on the AP radiographs. The lateral radiographswere 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 upperlimits, mean and median values of the measurements were recorded.Results: The measurements on the AP radiographs were determinedto 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 didnot show any difference in terms of the variables of age, gender andside (p=0.070, p=0.219 and p=1.0, respectively). These measurementson the AP radiographs showed a high statistical consistency in termsof side (p=0.72, p=1.0, p=0.900 and p=0.920, respectively). Themeasurements 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, theATFR 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). Thelateral 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 reliableand the intraoperative evaluation of its high consistency withthe opposite extremity is appropriate to avoid overcompression.The evaluation of ATFR on lateral radiographs was found to bereliable and evaluation is recommended to avoid intraoperativemalreduction.