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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP-
dc.contributor.authorNETTO, Cesar de Cesar-
dc.contributor.authorPINTO, Martim-
dc.contributor.authorROBERTS, Lauren-
dc.contributor.authorLEE, Sung Ro-
dc.contributor.authorRONEY, Andrew R.-
dc.contributor.authorNARANJE, Sameer-
dc.contributor.authorGODOY-SANTOS, Alexandre Leme-
dc.contributor.authorSHAH, Ashish-
dc.identifier.citationINJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, v.49, n.10, p.1758-1762, 2018-
dc.description.abstractIntroduction: Precise diagnosis of distal tibiofibular syndesmotic injury is challenging, and a gold standard diagnostic test has still not been established. Tibiofibular clear space identified on radiographic imaging is considered the most reliable indicator of the injury. The Cotton test is the most widely used intraoperative technique to evaluate the syndesmotic integrity although it has its limitations. We advocate for a novel intra operative test using a 3.5 mm blunt cortical tap. Methods: Tibiofibular clear space was assessed in nine cadaveric specimens using three sequential fluoroscopic images. The first image was taken prior to the application of the tap test (intact, non-stressed). Then, a 2.5 mm hole was drilled distally on the lateral fibula, and a 3.5 mm cortical tap was then threaded in the hole. The tap test involved gradually advancing the blunt tip against the lateral tibia, providing a tibiofibular separation force (intact, stressed). This same stress was then applied after all syndesmotic ligaments were released (injured, stressed). Measurements were compared by one-way ANOVA and paired Student's t-test. Intra and inter-observer agreements were evaluated by intraclass correlation coefficient (ICC). P-values <.05 were considered significant. Results: We found excellent intra-observer (0.97) and inter-observer (0.98) agreement following the imaging assessment. Significant differences were found in the paired comparison between the groups (p <.05). When using an absolute value for TFCS >6 mm as diagnostic for coronal syndesmotic instability, the tap test demonstrated a 96.3% sensitivity and specificity, a 96.3% PPV and NPV and a 96.3% accuracy in diagnosing coronal syndesmotic instability. Conclusions: Our cadaveric study demonstrated that this novel coronal syndesmotic instability test using a 3.5 mm blunt cortical tap is a simple, accurate and reliable technique able to demonstrate significant differences in the tibiofibular clear space when injury was present. It could represent a more controlled and stable alternative to the most used Cotton test.-
dc.publisherELSEVIER SCI LTD-
dc.relation.ispartofInjury-International Journal of the Care of the Injured-
dc.subjectAnkle fracture-
dc.subjectSyndesmotic injury-
dc.subjectSyndesmotic instability-
dc.subjectCotton test-
dc.subjectMalleolar fracture-
dc.subject.otherdistal tibiofibular syndesmosis-
dc.subject.otherankle fractures-
dc.titleIntraoperative tap test for coronal syndesmotic instability: A cadaveric study-
dc.rights.holderCopyright ELSEVIER SCI LTD-
dc.subject.wosCritical Care Medicine-
dc.subject.wosEmergency Medicine-
dc.type.categoryoriginal article-
dc.type.versionpublishedVersion-, Cesar de Cesar:Hosp Special Surg, Dept Foot & Ankle Orthoped, 535 East 70th St, New York, NY 10021 USA; UAB, Dept Orthoped, Birmingham, AL 35294 USA-, Martim:UAB, Dept Orthoped, Birmingham, AL 35294 USA-, Lauren:Hosp Special Surg, Dept Foot & Ankle Orthoped, 535 East 70th St, New York, NY 10021 USA-, Sung Ro:UAB, Dept Orthoped, Birmingham, AL 35294 USA-, Andrew R.:Hosp Special Surg, Dept Foot & Ankle Orthoped, 535 East 70th St, New York, NY 10021 USA-, Sameer:UAB, Dept Orthoped, Birmingham, AL 35294 USA-, Ashish:UAB, Dept Orthoped, Birmingham, AL 35294 USA-
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Artigos e Materiais de Revistas Científicas - HC/IOT
Instituto de Ortopedia e Traumatologia - HC/IOT

Artigos e Materiais de Revistas Científicas - LIM/41
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético

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