Beyond the pillars of the ankle: A prospective randomized CT analysis of syndesmosis' injuries in Weber B and C type fractures Massimiliano Carrozzo a, *, Giovanni Vicenti a , Vito Pesce a , Giuseppe Solarino a , Francesco Rifino a , Antonio Spinarelli a , Caterina Campagna b , Davide Bizzoca a , Biagio Moretti a a School of Medicine, University of Bari “Aldo Moro”, AOU Policlinico Consorziale, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy b Unit of Radiology Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy A R T I C L E I N F O Article history: Received 28 September 2018 Received in revised form 3 October 2018 Accepted 4 October 2018 Keywords: Syndesmosis injury Malleolar fracture CT scan AOFAS Tibiofibular anatomy A B S T R A C T Background: This study compared clinical and radiographic results of patients who underwent stabilization of syndesmosis with one tricortical syndesmotic screw divided into three different groups: Group A without preoperative fractured ankle computed tomography (CT) scan, Group B with preoperative fractured CT scan, and Group C with preoperative bilateral ankle CT analysis. Methods: Between June 2016 and May 2017, fifty-one patients with fracture type AO/OTA 44 B and C were analyzed. Of those, 14 (27.45%) were assigned to Group A, 19 (37.25%) to Group B, and 18 (35.30%) to Group C. Clinical outcomes with AOFAS score at 3, 6 and 12 months were recorded. Seven measurements on axial CT scan images were confronted between the injured and uninjured ankle to check the accuracy of reduction. Results: At three months of follow up the median AOFAS score was 70.86  2.98 with no significative difference between groups (p = 0.105). At 12 months of follow up the median AOFAS score was higher in group C (93.44  3.01) compared to Group B and Group C. The seven variables measured at the CT scan after syndesmotic reduction were statistically different between groups. We found a better restoration of the tibiofibular distances and the correct ankle anatomy in Group C respect to Group A and Group B. Conclusions: Use of the pre-operative CT scan of the injured and uninjured ankle give to the surgeons the more and accurate information for the reduction and help him intraoperative in the correct maneuvers. The accuracy of the syndesmosis reduction determines better clinical outcomes. © 2018 Published by Elsevier Ltd. Ankle fractures are common, representing the 10.2% of all fractures [1]. It is reported that syndesmosis injury occurs in 10%–13% and 20% requiring internal fixation [2,3]. The AO-OTA developing a classification based on the location of the fracture lines and on the degree of comminution [4]. This classification, describe the severity and degree of instability associated with a specific fracture pattern. The syndesmosis stabilizes the ankle mortise and maintains the tibiofibular relationship. Despite using a suture-button (SB) device to treat distal tibiofibular syndesmotic injuries is overwhelming in the last years, similar functional outcome (measured on the AOFAS score) and postoperative complication rate compared with the syndesmotic screw (SS) fixation were described in the literature [5]. Multiple studies have shown a high rate of syndesmotic malreduction with the placement of syndesmotic screws [2, 6, 7]. The purpose of this study is to compare clinical and radiographic results after stabilization of malleolar fracture with syndesmotic disruptions treated surgically with one 3.5 mm tricortical SS. The hypothesis was that there would be a difference in the accuracy of the reduction between patients with preopera- tive bilateral CT scan compared to patients without preoperative CT analysis of the ankles. Material and methods The study was approved by our regional ethics committee and our institutional board (N  BF23S42ID). Informed consent was obtained from all patients included in the study. * Corresponding author at: Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic Clinic, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70100, Bari, Italy. E-mail address: doc.mcarrozzo@gmail.com (M. Carrozzo). https://doi.org/10.1016/j.injury.2018.10.005 0020-1383/© 2018 Published by Elsevier Ltd. Injury, Int. J. Care Injured xxx (2018) xxx–xxx G Model JINJ 7875 No. of Pages 7 Please cite this article in press as: M. Carrozzo, et al., Beyond the pillars of the ankle: A prospective randomized CT analysis of syndesmosis’ injuries in Weber B and C type fractures, Injury (2018), https://doi.org/10.1016/j.injury.2018.10.005 Contents lists available at ScienceDirect Injury journal homepa ge: www.elsev ier.com/locate /injury