{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:09:10Z","timestamp":1771488550623,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,11,27]],"date-time":"2017-11-27T00:00:00Z","timestamp":1511740800000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the utility and medium\u2010term results of a new intra\u2010operative classification system for distal tibiofibular syndesmosis injury in ankle fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2010 and January 2015, 116 patients diagnosed with displaced closed Weber B and C ankle fractures were treated in our department. The etiology of injury was 56 cases of fall\u2010sprain, 36 of traffic injury, 14 of fall from a height, and 10 of multiple injuries. After fixation of the fibular fracture, we classify syndesmosis stability as either normal or one of three grades of instability using the fibular hook traction test. This determined further fixation selection and final syndesmosis treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 116 cases, 82 (71%) demonstrated a tibiofibular syndesmosis injury and 52 (45%) were unstable. Twenty\u2010six cases were <jats:styled-content style=\"fixed-case\">t<\/jats:styled-content>ype I injuries (&lt;4 mm displacement), 41% cases were type <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> injuries (4\u20137 mm displacement), and 3% of cases were type <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> injuries (&gt;7 mm displacement). Types <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> are defined as unstable and require stabilization. Type <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> injuries have multiplanar instability and require two screws at the syndesmosis. Weber C fractures demonstrate significantly greater degrees of instability than Weber B fractures (\u03c7<jats:sup>2<\/jats:sup> = 15.50, <jats:styled-content style=\"fixed-case\"><jats:italic>P<\/jats:italic><\/jats:styled-content> = 0.0014). All patients were followed up for 12\u201324 months, with no cases of non\u2010union or broken screws. Good and excellent results were achieved in 93% of cases (according to the American Orthopaedic Foot and Ankle Society scoring system).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The syndesmosis instability classification system provides a rational and efficient basis for managing syndesmosis instability. Our results from application of the algorithm justify its further evaluation in the treatment of patients with closed displaced Weber B and C ankle fractures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12355","type":"journal-article","created":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T13:34:59Z","timestamp":1512135299000},"page":"365-371","source":"Crossref","is-referenced-by-count":8,"title":["A New Intraoperative Syndesmosis Instability Classification System: Utility and Medium\u2010term Results in Closed Displaced Ankle Fractures"],"prefix":"10.1111","volume":"9","author":[{"given":"Hai\u2010bin","family":"Qiu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics First Affiliated Hospital of Tsinghua University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics First Affiliated Hospital of Tsinghua University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics First Affiliated Hospital of Tsinghua University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,11,27]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2006.07.002"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.bot.0000177105.53708.a9"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2012.672091"},{"key":"e_1_2_5_5_1","first-page":"603","article-title":"Surgical treatment of ankle fractures","volume":"22","author":"Liang J","year":"2002","journal-title":"Zhonghua Gu Ke Za Zhi"},{"key":"e_1_2_5_6_1","first-page":"2029","volume-title":"Mann's Surgery of the Foot and Ankle","author":"Coughlin 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