• Maxim Privalov, Benedict Swartman, Nils Beisemann, Jan El Barbari, Jochen Franke, Paul Alfred Grützner, and Sven Vetter.
• MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Germany.
• Eur J Trauma Emerg Surg. 2022 Apr 1; 48 (2): 1445-1452.

PurposeThe aim of the cadaveric study was to determine the effects of an unstable ankle fracture on the position of the fibula in the incisural notch and subsequently to evaluate the alterations resulting from the individual steps of a guideline-based osteosynthesis.MethodsIn a specimen model with 20 uninjured fresh-frozen lower legs with induced unstable fracture of the fibula (type Weber C), a guideline-based osteosynthesis was performed. The distances between the anterior and posterior edges of the tibia and fibula and in the center of the incisural notch, as well as the rotation angle of the fibula, were measured in the acquired 3D image data sets and were compared with the intact condition of the ankle mortise.ResultsThe dissection of the syndesmosis and osteotomy of the fibula results in an external rotation the fibula by 3.6° (p = 0.000), while the distance between the anterior edge of the tibia and the fibula widens by 1.86 mm (p = 0.000). After osteosynthesis of the fibula and transfixation of the syndesmotic region using a positioning screw, the posterior distance is no longer substantially increased by 0.22 mm (p = 0.103) but also reduced by 0.1 mm (p = 0.104) in the tibiofibular notch. The external rotation of the fibula remains slightly increased by just 0.45° (p = 0.009).ConclusionThe results indicate that there is a tendency for over-compression when adjusting the tibiofibular distance and that the fibula in the tibiofibular notch tends to remain slightly rotated externally.© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

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