The role of Iso-C3D in crush injuries to the distal lower syndesmosis: A technical report

Background Ankle syndesmotic injuries have become issues of increased interest. It has been shown that syndesmotic malreduction causes ankle pain. Intraoperative assessment for adequate reduction was limited until now to 2D fluoroscopy and clinical impression. Recently Iso-C3D imaging has been introduced as a tool for intraoperative assessment of syndesmotic reduction. This imaging modality provides CT data on the quality of reduction. Methods Fifteen patients with a diagnosis of type C crush injury of the ankle were operated on at our institution using the Iso-C3D technology. They all needed secondary soft-tissue procedures. The quality of syndesmotic reduction was evaluated using Iso-C3D before definitive wound closure. Results The mean added operative time when using Iso-C3D imaging was 7 minutes. In six patients (40%) the Iso-C3D scan caused alteration of the surgical positioning of the syndesmotic screws. In two patients other concomitant periarticular injuries were detected, not having been diagnosed before surgery. Conclusions Iso-C3D imaging is a powerful tool in orthopaedic trauma. This paper demonstrates its specific role in the treatment of complex fracture of the distal tibiofibular complex with severe crush and soft-tissue damage.