Intraoperative reduction of distal tibiofibular joint aided by three-dimensional fluoroscopy

Objective: The aim of the study was to demonstrate the surgical work-flow of the intraoperative 3D fluoroscopy (Acadis)-aided reduction for distal tibiofibular joint. Material and method: Ten ankle fracture patients with dislocated syndesmosis were treated. The surgical work-flow of intraoperative 3D (Acadis)-fluoroscopy-aided reduction was described. Axial imaging was measured for quality of syndesmotic reduction by measuring the distance between the fibular and the posterior and anterior facet of tibial incisura along a line perpendicular to joint space. Result: Acadis 3D scan was successfully accomplished. The syndesmosis of the healthy side was symmetrical. The asymmetry of syndesmosis prior to transsyndesmotic fixation (D) was 3.7 mm on average (2.2-8.2 mm). The asymmetry of syndesmosis after transsyndesmotic fixation (E) was 1.7 mm on average (1.2-4.2 mm). Conclusion: Intraoperative 3D-fluoroscopy was able to detect subtle malreduction of the syndesmosis in the operative treaetment of ankle fractures. The intraoperative 3D-fluoroscopy-aided reduction for the distal tibiofibular syndesmosis is effective.