Objective: 36 patients (male:female= 26:10, mean age 40.6 years) with ankle fractures treated with osteosynthesis including a syndesmotic screw were enrolled in this prospective study. Instability of the distal syndesmosis was proven intraoperatively and then a quadricortical syndesmotic screw was placed.

Patients were mobilized with an AirCast^® ankle brace and cranes for six weeks, then the syndesmotic screw was removed and patients started full weight bearing.

Using the x-rays of the ankle before and after and the CT of both ankles before removal of the syndesmotic screw we evaluated the radiologic results: the syndesmotic interval in the axial cuts, the Espace claire de Chaput (total clear space, TCS) und the medial clear space (MCS). Ventralization of the fibula as a measurement for the position of the fibula in the incisura was defined as the difference between the vertical reference lines of tibia and fibula in the CT. The functional results were evaluated by the scores of Phillips, Olerud/Molander and Weber.

Results: The mean axial interval difference was 0.83 mm (range -2.6 – 4.5), in seven case (19.4%) the interval had been over corrected. There was one case of subluxation of the talus (2.8%). In 3 patients (8.3%) the syndesmotic screw had been corrected in a second operation after the first CT, in 2 cases (5.6%) the syndesmotic screw had been placed after there was suspection of syndesmotic insufficiency in the x-rays which had been verified by CT. Mean ventralization of the fibula was 2.3mm (range 0–6.4). Average TCS was 5.3 mm (range 3.0 – 8.8), mean MCS was 3.3 mm (range 1.0 – 8.2).

The functional scores showed good to very good results in most patients.

Conclusions: Only with CT, the correct placement of the syndesmotic screw can be verified, the syndesmotic interval in the axial cuts can be evaluated and the position of the fibula in the Incisura fibularis can be assesed, therefore CT should be postoperative standard after syndesmotic screw placement. If an ankle fracture has not been treated with a syndesmotic screw, postoperative CT of both ankles should be done in any radiological or clinical suspicion of syndesmotic insufficiency.

Objective: 15 patients (male:female= 9:6, mean age 39,5 years) with ankle fractures treated with osteosynthesis including a syndesmotic screw were enrolled in this prospective study. Instability of the distal syndesmosis was proven intraoperatively and then a tricortical syndesmotic screw was placed.

Patients were mobilized with an AirCast®e brace and cranes for six weeks, then the syndesmotic screw was removed and patients started full weight bearing. Follow-Up was 21.7 weeks mean after removal of the syndesmotic screw.

Using the x-rays of the ankle after and the CT of both ankles before removal of the syndesmotic screw we evaluated the radiologic results: the syndesmotic interval in the fontal and axial cuts, the Espace claire de Chaput (total clear space, TCS) und the medial clear space (MCS). The functional results were evaluated by the scores of Phillips, Olerud/Molander and Weber.

Results: The mean frontal interval difference was 0,3 mm und the mean axial interval difference was 0,5 mm, in one case Fall (6,7%) there was a axial interval difference of 2 mm and in one case the interval had been over corrected. There was no subluxation of the talus in any patient. In 3 patients (20%) the syndesmotic screw had been placed in a second operation, after there was suspection of syndesmotic insufficiency in the x-rays which had been verified by CT. After implantation of the screw the CT scan showed regular syndesmotic intervals. Average TCS was 5.3 (range 3.40 – 7,40), mean MCS was 2.2 (range 1.0 – 4.5).

Average functional scores were: Phillips 118.53 (range 53 – 135), Olerud/Molander 93 (range 60 – 100) and Weber 2.33 (range 0 – 12).

Conclusions: Only with CT, the correct placement of the syndesmotic screw can be verified, the syndesmotic interval in the axial cuts can be evaluated and the position of the fibula in the Incisura fibularis can be assesed, therefore CT should be postoperative standard after syndesmotic screw placment. If an ankle fracture has not been treated with a syndesmotic screw, postoperative CT of both ankles should be done in any radiological or clinical suspicion of syndesmotic insufficiency.

Endoscopic techniques lead to higher numbers of anterior procedures to the vertebral column. Navigation systems can assist to more precision using less x-rays. We registered prospectively more than 100 cases of anterior stabilization of the thoracic and lumbar spine using minimally invasive technique, endoscopic assistance and CT-based navigation. Patients were observed continuously over a time period of at least 12 month according to a standardized protocol.

135 patients were recorded prospectively between January 2002 September 2004. All patients recieved anterior procedures using endoscopical assistance. Operations were performed in prone position using Synframe® and navigation system by BrainLab®. The follow up of at least one year consisted in clinical investigations and radiographs 6 weeks, 3, 6, 9 and 12 months post OP.

87 male and 48 female patients were recorded with a mean age of 41 (16–77) years. 47 isolated anterior and 88 combined antero-posterior spondylodeses were performed with the described technique. In 101 cases thoracoscopy was used. For the instrumentation of L3, mini-lumbotomy was necessary which was also combined with Synframe® and endoscopical assistance. Isolated anterior procedures were completed under navigation control in 29 and combined antero-posterior procedures in 71 cases. Image intensifier times were reduced up to 85%, op-times were shortened using navigation for a mean of 22 minutes.

Navigation procedures showed initial learning curve. However, after this initial time it was a useful techique to enlarge precision and reduce op-times as well as x-ray exposition. The further standardization of the procedure lead to the development of advantageous instruments that further on will lead to even higher acceptance of this new technique.