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Detecting factors of Syndesmotic injury in Ankle Fx . in radiograph

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

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Detecting factors of Syndesmotic injury in Ankle Fx . in radiograph

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  1. Detecting factors of Syndesmotic injury in Ankle Fx. in radiograph 분당서울대학교병원 최영

  2. Ankle Fracture • Indrect ankle Fx. • One of the most common injury on OS

  3. Ankle Anatomy

  4. Ankle Anatomy

  5. Ankle Fracture • Lauge-Hansen Classification

  6. Ankle Fracture • Lauge-Hansen Classification • Supination - External Rotation • SupinationAddution • Pronation - External Rotation • PronationAddution

  7. Ankle Fracture • Lauge-Hansen Classification • Supination - External Rotation • Supination Adduction • Pronation - External Rotation • PronationAddution

  8. Ankle Fracture • Lauge-Hansen Classification • Supination - External Rotation • SupinationAddution • Pronation - External Rotation • PronationAddution

  9. Ankle Fracture • Lauge-Hansen Classification • Supination - External Rotation • SupinationAddution • Pronation - External Rotation • PronationAddution

  10. SER type

  11. 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

  12. Hypothesis • Bony attenuation vsSyndesmosis

  13. Hypothesis • Bony attenuation vsSyndesmosis

  14. 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

  15. Measurement Method • 3-Dimension CT • X-ray (Mortise view)

  16. Radiographic measurement • Fracture height • Fracture length • Medial joint space • Bony attenuation

  17. Fracture height

  18. Medial joint space

  19. Fracture length

  20. Bony attenuation (Lat. Malleolus)

  21. Bony attenuation (Med. Malleolus)

  22. Bony attenuation (Talus)

  23. Ankle Mortise view

  24. Fracture height

  25. Medial joint space

  26. Statistical Method • median, interquatile range(IQR) and proportions • 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)

  27. 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

  28. 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

  29. 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

  30. Result : CT AUC : 0.765

  31. Result : CT AUC : 0.731

  32. Result : CT AUC : 0.753

  33. 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

  34. Result : CT AUC : 0.569

  35. Result : X-ray AUC : 0.779

  36. Result : X-ray AUC : 0.726

  37. 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

  38. Conclusion • Consideration of treatment on Ankle Fx. • Predictive Factors of Syndesmotic injury

  39. Thank you for your attention

  40. Discussion • X-ray, CT • Factors to detect syndesmotic injury • Limitation • Retrospective study • Technical problem in radiograph

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