{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T23:04:40Z","timestamp":1783983880118,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004607","name":"Natural Science Foundation of Guangxi Province","doi-asserted-by":"publisher","award":["2023GXNSFAA026002"],"award-info":[{"award-number":["2023GXNSFAA026002"]}],"id":[{"id":"10.13039\/501100004607","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Distal tibiofibular syndesmotic instability in Weber B ankle fractures remains challenging, as fixation constructs and insertion parameters alter ankle biomechanics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 3D finite element ankle model was developed from CT\/MRI data of a healthy adult. Residual instability was simulated by transecting the anterior inferior tibiofibular and interosseous ligaments after anatomical reduction and fixation of all malleolar fractures. Eighteen fixation models were created using tricortical screws or suture-buttons, placed 20, 30, or 40\u2005mm above the tibial plafond with anterior tilt angles of 12.5\u00b0, 27.5\u00b0, or 42.5\u00b0. Outcomes included peak tibiotalar contact stress, fibular displacement, and peak implant von Mises stress under axial loading and external rotation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Residual instability increased peak tibiotalar contact stress by 36.8% and markedly increased fibular translation. Fixation at 20\u201330\u2005mm restored near-physiologic mechanics, while 40\u2005mm fixation showed biomechanical deterioration. At equivalent heights, tricortical screws better restrained fibular translation, whereas suture-buttons preserved more micromotion but had higher implant stress concentrations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fixation height had a larger biomechanical effect than anterior tilt angle. Fixation 20\u201330\u2005mm above the tibial plafond is recommended, with construct selection balancing rigidity and physiologic syndesmotic motion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1890743","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T22:10:21Z","timestamp":1783980621000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fixation height has a greater biomechanical effect than anterior tilt angle in syndesmotic fixation for weber B ankle fractures: a specific finite element study"],"prefix":"10.3389","volume":"13","author":[{"given":"Dong","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University","place":["Nanning, Guangxi, China"]},{"name":"Department of Orthopedics, Loudi Central Hospital","place":["Loudi, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of 120 Emergency Station, Loudi Central Hospital","place":["Loudi, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianwen","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Traumatology and Hand Surgery, The First Affiliated Hospital to Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"102260","DOI":"10.1016\/j.jcot.2023.102260","article-title":"Current concepts in ankle fractures","volume":"45","author":"Tansey","year":"2023","journal-title":"J Clin Orthop Trauma"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1053\/j.jfas.2022.01.010","article-title":"An updated epidemiology of foot and ankle fractures in the United States: complications, mechanisms, and risk factors","volume":"61","author":"Hansen","year":"2022","journal-title":"J Foot Ankle Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1007\/s00167-015-3942-8","article-title":"Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines","volume":"24","author":"van Dijk","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"B4","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1007\/s12306-023-00802-0","article-title":"Osteoarthritis after an ankle fracture: we can't really avoid it","volume":"107","author":"Faldini","year":"2023","journal-title":"Musculoskelet Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/24730114211012701","article-title":"Biomechanics of the distal tibiofibular syndesmosis: a systematic review of cadaveric studies","volume":"6","author":"Khambete","year":"2021","journal-title":"Foot Ankle Orthop"},{"key":"B6","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1097\/01.blo.0000129152.81015.ad","article-title":"Radiographic measurement of the distal tibiofibular syndesmosis has limited use","author":"Beumer","year":"2004","journal-title":"Clin Orthop Relat Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"847","DOI":"10.2106\/00004623-199506000-00005","article-title":"The tibiofibular syndesmosis: evaluation of the ligamentous structures, methods of fixation, and radiographic assessment","volume":"77","author":"Xenos","year":"1995","journal-title":"J Bone Joint Surg Am"},{"key":"B8","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1177\/107110079301400308","article-title":"Tibiotalar joint dynamics: indications for the syndesmotic screw\u2014a cadaver study","volume":"14","author":"Burns","year":"1993","journal-title":"Foot Ankle"},{"key":"B9","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1053\/j.jfas.2020.08.005","article-title":"Comparison of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury: a meta-analysis","volume":"60","author":"Xu","year":"2021","journal-title":"J Foot Ankle Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"4805","DOI":"10.3390\/jcm13164805","article-title":"Is there any purpose in routine syndesmotic screw removal? 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