Prospective study of 38 patients with unstable external rotation ankle fractures comparing intraoperative fluoroscopic ER stress testing against preoperative radiographs and biomechanical criteria (Boden) for detecting syndesmotic instability requiring fixation.
When fixing any external rotation ankle fracture — including SER-IV patterns you'd otherwise consider low-risk — perform an intraoperative ER stress fluoroscopy after malleolar fixation: one in three will have occult syndesmotic instability that changes your construct.
Rely on the mortise-view TFCS, not the AP, as your intraoperative measurement; and don't assume medial fixation has solved the syndesmosis problem — it reduces but does not eliminate diastasis in the setting of true syndesmotic disruption.
Prospective study of 38 patients with unstable external rotation ankle fractures comparing intraoperative fluoroscopic ER stress testing against preoperative radiographs and biomechanical criteria (Boden) for detecting syndesmotic instability requiring fixation.
When fixing any external rotation ankle fracture — including SER-IV patterns you'd otherwise consider low-risk — perform an intraoperative ER stress fluoroscopy after malleolar fixation: one in three will have occult syndesmotic instability that changes your construct.
Rely on the mortise-view TFCS, not the AP, as your intraoperative measurement; and don't assume medial fixation has solved the syndesmosis problem — it reduces but does not eliminate diastasis in the setting of true syndesmotic disruption.