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Skeletal Radiology
Published in: Skeletal Radiology 9/2019

01-09-2019 | Computed Tomography | Scientific Article

Torque application helps to diagnose incomplete syndesmotic injuries using weight-bearing computed tomography images

Authors: Nicola Krähenbühl, Travis L. Bailey, Angela P. Presson, Chelsea McCarty Allen, Heath B. Henninger, Charles L. Saltzman, Alexej Barg

Published in: Skeletal Radiology | Issue 9/2019

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Abstract

Objective

Accurate identification of distal tibio-fibular syndesmotic injuries is essential to limit potential deleterious post-traumatic effects. To date, conventional radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) have shown limited utilization. This cadaver study evaluates the utility of weight-bearing CT scans on the assessment of incomplete and more complete syndesmotic injuries.

Materials and methods

Ten male cadavers (tibial plateau to toe-tip) were included. Weight-bearing CTs were taken under four test conditions, with and without torque on the tibia (corresponding to external rotation of the foot and ankle). First, intact ankles (native) underwent imaging. Second, the anterior–inferior tibio-fibular ligament (AITFL) was transected (condition 1). Then, the deltoid ligament (condition 2) was transected, followed by the interosseous membrane (IOM, condition 3). Finally, the posterior–inferior tibio-fibular ligament (PITFL) was transected (condition 4). The medial clear space (MCS), the tibio-fibular clear space (TFCS), and the tibio-fibular overlap (TFO) were assessed on digitally reconstructed radiographs (DRRs), and on axial CT images.

Results

The TFO differentiated isolated AITFL transection from native ankles when torque was applied. Also under torque conditions, the MCS was a useful predictor of an additional deltoid ligament transection, whereas the TFCS identified cadavers in which the PITFL was also transected.

Conclusion

Torque application helps to diagnose incomplete syndesmotic injuries when using weight-bearing CT. The TFO may be useful for identifying incomplete syndesmotic injuries, whereas the MCS and TFCS predict more complete injuries.
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Metadata
Title
Torque application helps to diagnose incomplete syndesmotic injuries using weight-bearing computed tomography images
Authors
Nicola Krähenbühl
Travis L. Bailey
Angela P. Presson
Chelsea McCarty Allen
Heath B. Henninger
Charles L. Saltzman
Alexej Barg
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 9/2019
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-019-3155-1

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