Journal article
Intraoperative tap test for coronal syndesmotic instability: A cadaveric study
Injury, Vol.49(10), pp.1758-1762
10/2018
DOI: 10.1016/j.injury.2018.08.005
PMID: 30115447
Abstract
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.
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.
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.
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.
Details
- Title: Subtitle
- Intraoperative tap test for coronal syndesmotic instability: A cadaveric study
- Creators
- Cesar de Cesar Netto - Hospital for Special Surgery, Department of Foot and Ankle Orthopedics, 535 East 70thStreet, New York, NY, 10021, United StatesMartim Pinto - University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United StatesLauren Roberts - Hospital for Special Surgery, Department of Foot and Ankle Orthopedics, 535 East 70thStreet, New York, NY, 10021, United StatesSung Ro Lee - University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United StatesAndrew R Roney - Hospital for Special Surgery, Department of Foot and Ankle Orthopedics, 535 East 70thStreet, New York, NY, 10021, United StatesSameer Naranje - University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United StatesAlexandre Leme Godoy-Santos - University of Sao Paulo (USP), Department of Orthopedics, Sao Paulo, SP, BrazilAshish Shah - University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United States
- Resource Type
- Journal article
- Publication Details
- Injury, Vol.49(10), pp.1758-1762
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.injury.2018.08.005
- PMID
- 30115447
- ISSN
- 0020-1383
- eISSN
- 1879-0267
- Language
- English
- Date published
- 10/2018
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984040440902771
Metrics
28 Record Views