PMID- 36266783 OWN - NLM STAT- MEDLINE DCOM- 20221215 LR - 20221215 IS - 1757-7861 (Electronic) IS - 1757-7853 (Print) IS - 1757-7853 (Linking) VI - 14 IP - 12 DP - 2022 Dec TI - Kirschner Wire as a Reference Marker for the Positioning of a Syndesmotic Screw: A Radiological Study and Clinical Evaluation. PG - 3251-3260 LID - 10.1111/os.13508 [doi] AB - OBJECTIVE: No consensus has been reached regarding optimal implantation for a syndesmotic screw. Thus, we aimed to explore the feasibility of a reliable and static fibular incisura plane reference for ideal syndesmotic screw placement. METHODS: A retrospective review of computed tomography (CT) scans of 42 uninjured adult ankles with foot fractures were analyzed to measure the tibiofibular vertical distance (TFVD) at 2.5 cm proximal to the plafond from August 2016 to June 2017 in our hospital. The patients (20 females, 22 males) were divided into four groups according to their TFVD: 0-1, 1-2, 2-3, and 3-4 mm, and patients in each group were counted. We retrospectively assessed 41 patients (15 females, 26 males) who underwent syndesmotic screw fixation for ankle fractures from December 2015 to June 2020. We performed t-testing of two independent samples to determine the differences in the angle between the anatomic axis of the syndesmosis and screw axis (AAS) and ankle function using the American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 and 6 months postoperatively between the conventional (20 patients) and K-wire marker (21 patients) groups. The correlation between the AAS and AOFAS score was analyzed. RESULTS: The TFVD measured 2.23 +/- 1.01 mm at 2.5 cm proximal to the plafond, and occurred at 25% of the distance from 2 to 3 mm in 47.6% of the patients. This new technique decreased AAS deformation by 62%, from 13.01 degrees +/- 2.84 degrees to 4.89 degrees +/- 2.43 degrees , in the conventional group (p < 0.001). At 3 months postoperatively, the AOFAS scores of ankle function were similar in both groups, but it was significantly better in the new group than that of conventional group at the 6-month follow-up (p = 0.024). There was a moderate negative correlation between AAS and AOFAS score at 6 months postoperatively (R = -0.684). No obvious complications affecting ankle function were observed in either group postoperatively. CONCLUSIONS: Surgeons can accurately place a screw trajectory using the fibular incisura plane as a reliable intraoperative reference. A 1.6-mm K-wire placed in the syndesmosis at 2.5 cm proximal to the tibial plafond could act as a static marker of the syndesmotic plane. CI - (c) 2022 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd. FAU - Zhang, Congming AU - Zhang C AUID- ORCID: 0000-0003-2651-2904 AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Zhang, Chengcheng AU - Zhang C AUID- ORCID: 0000-0002-4733-7191 AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Huang, Qiang AU - Huang Q AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Sun, Liang AU - Sun L AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Ren, Chen AU - Ren C AUID- ORCID: 0000-0001-7514-4939 AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Lu, Yao AU - Lu Y AUID- ORCID: 0000-0002-5345-5231 AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Xu, Yibo AU - Xu Y AUID- ORCID: 0000-0003-4923-4820 AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Lin, Hua AU - Lin H AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Zhang, Kun AU - Zhang K AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Ma, Teng AU - Ma T AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. FAU - Li, Zhong AU - Li Z AD - Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China. LA - eng PT - Journal Article DEP - 20221020 PL - Australia TA - Orthop Surg JT - Orthopaedic surgery JID - 101501666 SB - IM MH - Humans MH - *Bone Screws MH - Retrospective Studies MH - *Fracture Fixation, Internal PMC - PMC9732627 OTO - NOTNLM OT - American Orthopaedic Foot and Ankle Society score OT - screw trajectory OT - syndesmosis OT - tibiofibular vertical distance COIS- We declare that all authors have no conflict of interest. EDAT- 2022/10/22 06:00 MHDA- 2022/12/15 06:00 PMCR- 2022/10/20 CRDT- 2022/10/21 01:02 PHST- 2022/08/22 00:00 [revised] PHST- 2021/11/15 00:00 [received] PHST- 2022/08/24 00:00 [accepted] PHST- 2022/10/22 06:00 [pubmed] PHST- 2022/12/15 06:00 [medline] PHST- 2022/10/21 01:02 [entrez] PHST- 2022/10/20 00:00 [pmc-release] AID - OS13508 [pii] AID - 10.1111/os.13508 [doi] PST - ppublish SO - Orthop Surg. 2022 Dec;14(12):3251-3260. doi: 10.1111/os.13508. Epub 2022 Oct 20.