Predicting Syndesmotic Injury in OTA/AO 44-B2.1 (Danis–Weber B) Fractures. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Kellam, Patrick J.; Dekeyser, Graham J.; Haller, Justin M.; Rothberg, David L.; Higgins, Thomas F.; Marchand, Lucas S.
• Is Part Of: Journal of orthopaedic trauma. Volume 35:Issue 9(2021)
• Publication Date: 2021-09
• Subjects: ankle fractures -- syndesmosis -- radiographs; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000002052
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objective: To establish if preoperative radiographs could predict the rate of syndesmotic injury. Setting: Level 1 trauma center. Design: Retrospective cohort study. Patients/Participants: There were 548 OTA/AO 44-B2.1 fractures that were reviewed, and 287 patients were included in the study. Main Outcome Measurements: Ankle radiographs were used to determine the zone of distal extent of the proximal fracture fragment. Syndesmotic injury was defined as positive intraoperative stress examination that required syndesmotic fixation. Results: There were 191 zone 1 (ending below the plafond) injuries, 57 zone 2 (ending between the physeal scar and the plafond) injuries, and 39 zone 3 (ending above the physeal scar) injuries. Of these, 17% (33 patients) of zone 1, 42% (24) of zone 2, and 74% (29) of zone 3 fractures had syndesmotic injuries. The relative risk of syndesmotic injury of zone 1 compared with zone 2 was 2.4 ( P < 0.001), zone 1 to zone 3 was 4.3 ( P < 0.001), and zone 2 to zone 3 was 1.8 ( P = 0.002). The interobserver and intraobserver reliability was excellent (κ = 0.86, 0.94). Conclusion: OTA/AO 44-B2.1 fractures have a varying rate of syndesmotic injury. Weber B fractures that end between the level of the plafond and the physeal scar (zone 2) are 2.4 times more likely to have a syndesmotic injury compared with those that end below the plafond (zone 1). This is magnified in those injuries ending above the scar (zone 3). This simple classification of OTA/AO 44-B2.1 fractures is predictive of syndesmotic injury and may aid in preoperative counseling and planning. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.