A case series of combined Ilizarov method and suture button fixation in neglected syndesmosis injury. Case series

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Abstract

BACKGROUND: There are known open, minimally invasive and reconstructive-plastic interventions to restore the distal intercostal syndesmosis, the postoperative rehabilitation protocols of which assume no load on the operated limb and immobilisation for 2 to 6 weeks with progressively increasing load after immobilisation with a plaster cast or orthosis. Closed percutaneous osteosynthesis of the shin bones with the Ilizarov fixator of the ankle and subtalar joints is a self-sufficient method in the treatment of ankle joint injuries accompanied by the failure of the distal intercostal syndesmosis. Neutral stable osteosynthesis with the Ilizarov fixator with a dosed volume of movement and joint decompression in combination with immersion fixators of the distal intercostal syndesmosis has not been described before.

CLINICAL CASES DESCRIPTION: The article presents three clinical cases demonstrating the possibilities of neutral stable osteosynthesis with the Ilizarov fixator both as a stand-alone method in the treatment of chronic lateral foot subluxations as well as in combination with fixation of the distal intertrochanteric syndesmosis using a button fixator. The new technology consists in the combined use of the Ilizarov apparatus in the treatment of chronic lateral foot subluxations due to its repositioning capabilities in rigid foot subluxations with the creation of controlled forces and controlled degree on fixation rigidity at any stage of treatment, fixation of the joint in a functionally favourable position to create a stable and correct position of implants and suture material for a period corresponding to the formation of mature scars, decompression and mechanical unloading in order to create a favourable condition of the foot.

CONCLUSION: The Ilizarov fixator in combination with dynamic systems of distal intertrochanteric syndesmosis fixation allows levelling the disadvantages of the method (restoration of relationships in the distal intertrochanteric joint by minimally invasive interventions with a minimum number of implants without compromising stability, short fixation time, which reduces the risk of complications, the requirement for outpatient follow-up, negative psychological aspects of external fixation conditions), while retaining its advantages (minimally invasive, manageable, and easy to use).

About the authors

Ilya V. Sutyagin

Ilizarov National Medical Research Centre for Traumatology and Orthopedics

Author for correspondence.
Email: pr_sutyagin@bk.ru
ORCID iD: 0000-0001-8446-1434
Russian Federation, Kurgan

Alexander V. Burtsev

Ilizarov National Medical Research Centre for Traumatology and Orthopedics

Email: bav31rus@mail.ru
ORCID iD: 0000-0001-8968-6528

MD, Dr. Sci. (Med.)

Russian Federation, Kurgan

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Supplementary files

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2. Fig. 1. a, b — preoperative coronal T1 magnetic resonance imaging of patient B., c — oblique-frontal plane computed tomography scan, d, e — axial T2 magnetic resonance imaging

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3. Fig. 2. a — postoperative A–P-view X-ray of patient B., b — lateral view X-ray, c, d — computer podography, e, f — gait analysis

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4. Fig. 3. 6 months postoperative magnetic resonance imaging of patient B.: a, b — T1 in coronal plane, c, d — T2 in axial plane

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5. Fig. 4. X-rays of patient K. after previous surgery: a, b — increased medial clear space, c — increased tibiofibular space, d — lateral X-ray

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6. Fig. 5. Postoperative X-rays of patient K.: a — A-P-view, b — lateral view, c, d — lateral X-rays demonstrating limited by hinges range of motion, e, f — gait analysis, g, h — computer podography

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7. Fig. 6. X-rays of patient K. after Ilizarov fixator removal: a — mortise view, b — lateral view

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8. Fig. 7. Preoperative X-rays of patient P.: a — A-P-view, b — lateral view, c — axial T1 magnetic resonance imaging, d — coronal T2 magnetic resonance imaging

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9. Fig. 8. Suture button placing after lateral subluxation reduction: a — drilling hole in fibula and tibia, b — suture tensioning

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10. Fig. 9. Postoperative X-rays of patient P.: a — A-P-view, b — lateral view, c, d — gait analysis, e, f — computer podography

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11. Fig. 10. X-rays of patient P. after Ilizarov fixator removal: a, b — mortise view, c — lateral view

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