Publication: Estudio prospectivo de validación de nuevos modelos predictivos preoperatorios de lesión sindesmal en fracturas de tobillo
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2022-10-27
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Universidad Complutense de Madrid
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Abstract
Aproximadamente un 23% de todas las fracturas de tobillo se asocian a lesión en la articulación tibiofibular distal o sindesmosis. En este contexto, la lesión de dos de sus tres estabilizadores mayores (ligamento tibiofibular anteroinferior, ligamento tibiofibular posteroinferior y ligamento interóseo) conduciría a una pérdida de más del 50%de la resistencia de la sindesmosis al estrés en rotación y desviación lateral, generando por tanto inestabilidad sindesmal. El diagnóstico de la lesión sindesmal puede suponer un reto ya que no existe ninguna característica clínica o radiológica que por sí misma sea indicativo inequívoco de la lesión y se considera que el diagnóstico de certeza dela inestabilidad sindesmal aguda en contexto de fractura de tobillo se establece mediante la exploración intraoperatoria en base a la interpretación de los hallazgos o pruebas de estrés realizadas. Un estudio previo propuso dos modelos de predicción preoperatoria de lesión sindesmal basados en la medida de un ángulo de reciente descripción: el ángulo crurofocal medial. Este ángulo está formado por la línea del trazo principal de fractura del maléolo medial con la línea perpendicular a la superficie de carga el pilón tibial para su medición en el contexto de fracturas de tobillo con implicación del maléolo interno...
An injury to the distal tibiofibular joint or syndesmosis occurs in 23% of ankle fractures, approximately. The injury to two of the three major stabilizers (anterior tibiofibular ligament, posterior tibiofibular ligament, or interosseous tibiofibular ligament) would lead to the loss of more than the 50% of the syndesmotic resistance to rotation and lateral translation, resulting in syndesmotic instability. The diagnosis of ankle syndesmotic injury is still challenging as there is no clinical or radiological sign that implies an injury unequivocally. Definitive diagnosis of acute syndesmotic instability is made intraoperative, according to the interpretation of anatomical findings or stress tests. Previous research proposed two preoperative prediction models for diagnosis of syndesmotic injury based on a recently described radiological variable: the medial crurofocal angle, formed by the main line of the medial malleolus fracture and the perpendicular line to bearing surface of the tibial plafond. The natural progression of a missed syndesmotic injury is the development of chronic syndesmotic instability and posttraumatic ankle osteoarthritis.
An injury to the distal tibiofibular joint or syndesmosis occurs in 23% of ankle fractures, approximately. The injury to two of the three major stabilizers (anterior tibiofibular ligament, posterior tibiofibular ligament, or interosseous tibiofibular ligament) would lead to the loss of more than the 50% of the syndesmotic resistance to rotation and lateral translation, resulting in syndesmotic instability. The diagnosis of ankle syndesmotic injury is still challenging as there is no clinical or radiological sign that implies an injury unequivocally. Definitive diagnosis of acute syndesmotic instability is made intraoperative, according to the interpretation of anatomical findings or stress tests. Previous research proposed two preoperative prediction models for diagnosis of syndesmotic injury based on a recently described radiological variable: the medial crurofocal angle, formed by the main line of the medial malleolus fracture and the perpendicular line to bearing surface of the tibial plafond. The natural progression of a missed syndesmotic injury is the development of chronic syndesmotic instability and posttraumatic ankle osteoarthritis.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 12-05-2022