Does the Level of Syndesmotic Screw Insertion Affect Clinical Outcome after Ankle Fractures with Syndesmotic Instability?

Comparison of Two Different Methods to Evaluate Ankle Syndesmosis on Lateral Ankle Radiographs

Background Ankle sprains and fractures rank among the most commonly occurring musculoskeletal injuries and hold significant relevance in current medical practice. Accurate information regarding these injuries is crucial for their effective treatment. This study aimed to explore the viability of utilizing ankle lateral radiographs to evaluate syndesmosis in both emergency settings and operating theatres. Methods This randomized retrospective clinical study involved the analysis of 150 ankle lateral radiographs (54 males and 96 females) from patients who presented at our emergency department with suspected ankle injuries. Two authors jointly examined these radiographs and reached a consensus. The anterior tibiofibular (ATF) ratio and anterior-posterior tibiofibular (APTF) ratio were computed. Patients requiring syndesmotic fixation were classified as having experienced a genuine syndesmotic injury. Participants were randomly divided into two equal groups: Group I (normal group) without fractures and Group II (abnormal group) with fractures. Comprehensive patient data, including medical history and clinical examinations, were recorded. Results Gender distribution within the studied population consisted of 54.67% males (n=41) and 45.33% females (n=34) in the abnormal group, while the normal group comprised 37.33% males (n=28) and 62.67% females (n=47). Both APTFR and ATFR methods were found to be inconclusive and unreliable for syndesmosis assessment in ankles. The sensitivity of APTFR stood at 21.33%, with a specificity of 86.67%, a positive predictive value (PPV) of 61.5%, and a negative predictive value (NPV) of 52.4%. Meanwhile, the sensitivity of ATFR was 32%, with a specificity of 80%, a PPV of 61.5%, and an NPV of 54.1%. Conclusions Both techniques demonstrated low sensitivity when ankle fractures were present, indicating their unsuitability for routine clinical diagnosis of syndesmotic disruption via lateral ankle radiographs.