Synesmotic Stocking Stuffer

by Vince Vacketta, DPM

As winter sets in, for many of us, both snow and your patients may be falling. ‘Tis the season to review some recent literature on ankle fractures. 

Center-center clamp placement study: CT quality reduction without the hassle?

The study was a cadaveric investigation designed to identify the optimal position for clamp placement on fluoroscopy. It found that a fluoroscopic “center-center” view for clamp placement accurately aligns with established CT-based axes for syndesmosis reduction. 

Suture-button CT study: Understand the fixation “creep”

This retrospective CT study evaluated the behavior of suture button fixation. The findings showed that the syndesmosis is initially over-compressed after fixation but gradually “settles” toward normal alignment over six months under physiologic load.

Key takeaways

• The center-center view provides CT-level accuracy for clamp placement. Even for those who do not use clamps, this view can still serve as a reliable and efficient guide for syndesmosis reduction.

• With the suture-button fixation, don't be alarmed by initial intraoperative over-compression, as the construct gradually settles under loadbearing. Interpret early postoperative imaging cautiously, with final alignment best assessed at roughly six months.