{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T03:03:48Z","timestamp":1778814228346,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Syndesmosis injury healing remains poorly understood, despite its high prevalence in ankle fractures. Unstable syndesmosis is commonly addressed with either syndesmosis screw (SS) or suture button (SB) fixation, and up to 20% of operated ankle fractures may require some form of syndesmosis fixation. However, in biomechanical studies no repair technique fully restores the preinjury rotational stability or the anatomical alignment of the tibiofibular joint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In a study of 39 patients with operatively treated supination external-rotation type 4 and pronation external-rotation type 4 ankle fractures and fixation of an unstable syndesmosis, weightbearing cone beam computed tomography with rotational stress was performed on both ankles at a mean follow-up of 7.8 (range, 6.2-10.3) years to evaluate tibiofibular syndesmosis dimensions and fibular rotation. Sagittal translation of the fibula (ST), anterior width (AW) and posterior width (PW) of the syndesmosis, tibiofibular clear space (TFCS), and fibular rotation (RO) were measured in neutral position and in maximal internal and external rotation. Mean change in measurements between maximal rotations were calculated to represent range of motion of the fibula under rotational stress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-six patients had screw fixation (SS) and 13 had suture button (SB) fixation of the syndesmosis. Eight SSs had been removed and 3 were broken. No SBs had been removed. The mean Olerud-Molander Ankle Score was 84.7 (SD 20.3). Fibular rotation demonstrated a mean difference of 2.7 degrees (95% CI, 1.3-4.1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.05) compared with the patient\u2019s non-injured ankle. Other measurements showed no significant differences; however, we lacked statistical power to detect significant changes in ST, AW, PW, and TFCS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Excess fibular rotation persists after healing of ankle fractures with fixed unstable syndesmosis. However, clinical relevance remains unclear and should be explored with larger patient groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007251392222","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T12:22:18Z","timestamp":1765196538000},"page":"216-223","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Rotational Dynamics of the Distal Tibiofibular Joint After Operative Treatment of Ankle Fractures With Syndesmosis Injury"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1546-6711","authenticated-orcid":false,"given":"Ristomatti","family":"Lehtola","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland"},{"name":"Medical Research Center Oulu, University of Oulu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3498-8048","authenticated-orcid":false,"given":"Tero","family":"Kortekangas","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland"},{"name":"Pihlajalinna Hospital Oulu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harri","family":"Pakarinen","sequence":"additional","affiliation":[{"name":"Pihlajalinna Hospital Oulu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iikka","family":"Lantto","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8245-3000","authenticated-orcid":false,"given":"Pasi","family":"Ohtonen","sequence":"additional","affiliation":[{"name":"Research Service Unit, Oulu University Hospital, Finland"},{"name":"Translational Medicine Research Unit, University of Oulu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaakko","family":"Niinim\u00e4ki","sequence":"additional","affiliation":[{"name":"Medical Research Center Oulu, University of Oulu, Finland"},{"name":"Department of Radiology, Oulu University Hospital, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannu-Ville","family":"Leskel\u00e4","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100717740330"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.23.00412"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720936596"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007241262771"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2021.07.014"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716666278"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3182535f30"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-009-0809-4"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01002"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.bot.0000177114.13263.12"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.02.004"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100714540894"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100719829720"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1950.01250010980011"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2021.06.025"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2021.03.014"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.15.00470"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716670156"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716634757"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3182a59b3c"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.08.066"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200410000-00007"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199501000-00020"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2011.03.019"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-14-109"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00435553"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2011.1103"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.bot.0000189591.40267.09"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07536-3"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e31822a526a"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-012-1500-2"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100716673590"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007231205576"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/036a3546518804804"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.12.8481"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.11.425"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2007.08.009"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.00094"}],"container-title":["Foot &amp; Ankle International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10711007251392222","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10711007251392222","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10711007251392222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T21:23:56Z","timestamp":1777411436000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10711007251392222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":38,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1177\/10711007251392222"],"URL":"https:\/\/doi.org\/10.1177\/10711007251392222","relation":{},"ISSN":["1071-1007","1944-7876"],"issn-type":[{"value":"1071-1007","type":"print"},{"value":"1944-7876","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}