{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T17:46:37Z","timestamp":1770140797177,"version":"3.49.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>To determine the outcomes of pilon and tibial shaft fractures with syndesmotic injuries compared with similar fractures without syndesmotic injury.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective case\u2013control study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Level 1 trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients\/Participants:<\/jats:title>\n            <jats:p>All patients over a 5-year period (2012\u20132017) with tibial shaft or pilon fractures with a concomitant syndesmotic injury and a control group without a syndesmotic injury matched for age, OTA\/AO fracture classification, and Gustilo\u2013Anderson open fracture classification.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>Preoperative or intraoperative diagnosis of syndesmotic injury with reduction and fixation of both fracture and syndesmosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measurement:<\/jats:title>\n            <jats:p>Rates of deep infection, nonunion, unplanned reoperation, and amputation in patients with a combined syndesmotic injury and tibial shaft or pilon fracture versus those without a syndesmotic injury.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>A total of 30 patients, including 15 tibial shaft and 15 pilon fractures, were found to have associated syndesmotic injuries. The matched control group comprised 60 patients. The incidence of syndesmotic injury in all tibial shaft fractures was 2.3% and in all pilon fractures was 3.4%. The syndesmotic injury group had more neurologic injuries (23.3% vs. 8.3% <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02), more vascular injuries not requiring repair (30% vs. 15%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.13), and a higher rate compartment syndrome (6.7% vs. 0%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.063). Segmental fibula fracture was significantly more common in patients with a syndesmotic injury (36.7% vs. 13.3%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.04). Fifty percent of the syndesmotic injury group underwent an unplanned reoperation with significantly more unplanned reoperations (50% vs. 27.5%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.04). The syndesmotic group had a significantly higher deep infection rate (26.7% vs. 8.3% <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.047) and higher rate of amputation (26.7% vs. 3.3% <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.002) while the nonunion rate was similar (17.4% vs. 16.7% <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.85).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Although syndesmotic injuries with tibial shaft or pilon fractures are rare, they are a marker of a potentially limb-threatening injury. Limbs with this combined injury are at increased risk of deep infection, unplanned reoperation, and amputation. The presence of a segmental fibula fracture should raise clinical suspicion to evaluate for syndesmotic injury.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000002252","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T07:00:58Z","timestamp":1630306858000},"page":"157-162","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment"],"prefix":"10.1097","volume":"36","author":[{"given":"Kevin F.","family":"Purcell","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick F.","family":"Bergin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 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