INTRODUCTION:Fracture nonunion develops in 5-10% of all fractures and the industry offers biological grafting solutions to address this. Autologous bone marrow aspirate (BMA) may represent an inexpensive alternative, minimally invasive, biologically active adjunct to surgery. OBJECTIVE:This scoping review aimed to analyze the current evidence on the effectiveness and safety of autologous bone marrow aspirate as a standalone treatment in patients with impaired fracture healing (minimum 3 months post-fracture). METHODS:The data was extracted from Embase, Medline, Cochrane Library, Web of Science, and ClinicalTrials.gov, up to October 30, 2024, and conducted according to the Joanna Briggs Institute Scoping Review Manual and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Randomized controlled trials, non-randomized trials, prospective or retrospective cohort studies, and case series with a minimum of five participants were included. Studies had to report on BMA as a standalone treatment for nonunion and assess at least one outcome related to effectiveness (ex: time to union, radiographic healing, etc.). Two members of the research team independently carried out the screening, selection, and data extraction processes, with a third member resolving any discrepancies. Descriptive data were presented in tabular form, while other findings were synthesized descriptively. RESULTS:Four hundred and sixty-nine articles were found, 55 met the inclusion criteria and 14 were included after full-text review (311 patients) Union rates ranged from 50% (3/6 patients) to 100%, with most studies reporting rates above 80%, within 1.5-10 months. Reported volume and density of injected BMA varied. There were no serious complications or donor-site morbidity. CONCLUSION:While union rates are encouraging, the absence of control groups across all included studies means that the contribution of BMA to these outcomes cannot be determined. Functional outcomes were not often assessed, and study heterogeneity limits a broader generalization. Defining the concentration and BMA volume needed appears as a next step to validate its effectiveness and guide clinical use, along with adequate control groups. LEVEL OF EVIDENCE:V.

BACKGROUND:Osteolysis after total elbow arthroplasty (TEA) remains a major concern, with an average 13%-15% loosening rate at 7 years. Two new radiological parameters of elbow anatomy could play a role in this complication: the posterior ulnar dorsal angulation (PUDA) and the radiocapitellar ratio (RCR). The primary objective of this study was to evaluate the association between PUDA and RCR on loosening after TEA. METHODS:This retrospective single-center study included all patients who underwent TEA from 1996 to 2021 with a minimum follow-up of 2 years. Patient evaluation included range of motion and function (Quick-Disabilities of the Arm, Shoulder and Hand, patient-rated elbow evaluation, and Mayo Elbow Performance Score [MEPS]). To assess implant position and limb length discrepancy, new bilateral upper limb radiographs were taken. Lateral elbow radiographs were taken to measure PUDA and RCR on the TEA side and native side. PUDA was considered high when >7°, and RCR was abnormal when <-5% or >13%. Radiographs were analyzed by an independent evaluator to assess loosening. RESULTS:Thirty-four TEAs from 30 patients available for assessment were included. The mean age was 64 years (range 42-86), and 90% (n = 27) were females. TEA was performed following trauma in 13 patients and secondary to degenerative conditions in 17 patients. The mean follow-up was 7.4 years. The mean PUDA and RCR were 6.7 and -1.2%, respectively. PUDA was high in 33% of patients, and RCR was abnormal in 53%. The MEPS score was significantly better in patients with a lower PUDA compared to those with a higher PUDA, 87 (±13) and 73 (±17), P = .038, respectively. A higher PUDA was not associated with humeral or ulnar component loosening (Humeral component: 40% vs. 9% loosening, P = .053; Ulnar component: 20% vs. 5% loosening, P = .251). Functional scores and loosening rates were not impacted by differences in RCR. CONCLUSIONS:PUDA had an impact on functional scores, with significantly better MEPS in patients with lower PUDA. PUDA was not statistically related to loosening of the humeral or ulnar components. RCR had no impact on loosening and outcomes after TEA in our study.

Introduction: Recent studies have shown a growing concern regarding the cost effectiveness and the lack of supporting data for the biologic agents that are being increasingly used in the orthopedic field. Our aim was to conduct a systematic scoping review of recent publications (last five years) on the use of orthobiologics to treat fracture nonunion and summarize the latest available data.Patients and Methods: The inclusion criteria for this review were articles published in English, from 2016 to 2022, and focusing on the use of orthobiologics for the surgical treatment of nonunion. Searches were conducted in March 2023 using Pubmed/MEDLINE and Embase. Studies on spinal fusion or gene therapy were excluded. Reviews, case reports with five cases or less, conference proceedings, preliminary reports, pediatric or non-human studies were excluded as well.Results: The search found 1807 articles, 15 were eligible after PRISMA checklist and exclusions. The evidence was heterogenous and there was only one level II RCT. Recent data suggests that bone morphogenic protein (BMP-2) products could be effective for septic and aseptic tibial nonunions. However, the evidence was not conclusive regarding BMP-7, plasma rich platelets (PRP), stem cells or demineralized bone matrix (DBM).Discussion: Every nonunion case is different in terms of bone defect, biology, mechanical stability, surgical technique and host factors, which contributes to the conflicting reports on the efficacy of orthobiologics in the literature. We might never see a level 1, high powered and robust study defining the efficacy, safety profile and cost-effectiveness of such products.Level of evidence: IV

Current literature suggests a significant epidemiological association between traumatic brain injury (TBI) and proximal upper limb fractures in addition to major clinical consequences. A systematic review was conducted to assess how TBI is taken into consideration in interventional studies on shoulder fractures. The following data sources were used: MEDLINE, EMBASE, EBM Reviews, CINAHL, and OpenGrey databases. Study selection included interventional randomized clinical trials and prospective cohort studies on shoulder fractures published in English or French between 2008 and 2020. Studies on pathologic fractures, chronic fracture complications, nonhuman subjects, and biomechanics were excluded. Articles were reviewed by two independent authors according to the PRISMA guidelines. Baseline characteristics, exclusion criteria, and input relevant to TBI were recorded. Methodological quality was assessed with the Cochrane risk of bias tool for randomized clinical trials and the Newcastle–Ottawa Scale for cohort studies. One-hundred-thirteen studies met the inclusion criteria. None discussed the possible impact of TBI on their results. Only three (2.7%) studies considered TBI relevant and included these patients in their cohort. Furthermore, 43/113 (38.1%) excluded patients with injuries or mechanisms strongly related to traumatic brain injuries: head injuries (4); moderate and/or severe TBI (7); high energy traumas (3); Polytrauma subjects (33). TBI are ignored or discriminated in prospective clinical trials on shoulder fractures. The exclusion of these cases impacts generalizability as their prevalence is significant. Considering the major impact of TBI on important outcomes, its presence should always be assessed to ensure high quality evidence. Systematic Review, Therapeutic Level II.

Background: Outcomes of bone marrow stimulation for osteochondritis dissecans (OCD) of the talus in pediatric patients is not optimal. The objective was to evaluate the retroarticular drilling technique for talar OCD.Methods: A retrospective case-series study of pediatric cases treated for talar OCD with retroarticular drilling was done. Clinical and radiological outcome scores were recorded as follows: the percentage of patients who had a successful treatment, the percentage for every category of the Berndt and Harty treatment result grading and the percentage for every radiographical outcome score were computed.Results: Nineteen patients (18 girls; mean age: 14.6 +/- 2.1 years) were included. The mean follow-up was 14.8 (+/- 11.7) months. 26.3% required revision surgery. The Berndt and Harty scores were: 57.9% good, 10.5% fair, 31.6% poor. Radiological outcomes were: 21% healed, 47.4% partially healed, 31.6% no healing. The radiological outcome score was better for younger patients (P = 0.01) and those with an open physis (P = 0.001).Conclusion: 26.3% of patients needed revision surgery after talar OCD retroarticular drilling and 21% were healed radiographically. Skeletal immaturity and a younger age were associated to a better radiological outcome.

Background Chronic opioid use has been documented in up to 20% of patients with traumatic injuries. Hence, we developed the Tapering Opioids Prescription Program for high-risk Trauma (TOPP-Trauma) patients. Aims To assess the feasibility and acceptability of TOPP-Trauma, examine the feasibility of the research methods, and describe its potential efficacy in reducing long-term opioid use. Design A two-arm pilot randomized controlled trial. Methods Fifty participants discharged home were assigned to TOPP-Trauma or an educational pamphlet. Feasibility was assessed based on ability to provide the program components. The acceptability was assessed with the Treatment Acceptability and Preference Questionnaire. The feasibility of the research methods was evaluated according to standard parameters. Self-reported morphine equivalent dose (MED) and MEDs supplied by pharmacies were measured at 6 and 12 weeks. Results Eighty percent or more of TOPP-Trauma components were delivered as planned, and the program was deemed highly acceptable. Approximately 10% of screened patients were eligible. Eighty-five percent of eligible patients agreed to participate with 20% attrition rates. TOPP-Trauma participants used less MED/day compared to the control group at 6 and 12 weeks (1.2. vs. 12.2 mg; 0.4. vs 4.0 mg), and pharmacies supplied less than half of cumulative MEDs to those who received the program at 12 weeks, but the differences were not statistically significant. Conclusions Some challenges need to be addressed before testing TOPP-Trauma. These include creating strategies to decrease attrition, offering the program throughout the care continuum to higher risk patients, and evaluating the impacts of reduced opioid use.

Background: Risk stratification of individual patients who are prone to infection would allow surgeons to monitor high-risk patients more closely and intervene early when needed. This could reduce infection-related consequences such as increased health-care costs. The purpose of this study was to develop a machine learning (ML)-derived risk-stratification tool using the SPRINT (Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures) and FLOW (Fluid Lavage of Open Wounds) trial databases to estimate the probability of infection in patients with operatively treated tibial shaft fractures (TSFs). Methods: Patients with unilateral TSFs from the SPRINT and FLOW trials were randomly split into derivation (80%) and validation (20%) cohorts. Random forest algorithms were used to select features that are relevant to predicting infection. These features were included for algorithm training. Five ML algorithms were trained in recognizing patterns associated with infection. The performance of each ML algorithm was evaluated and compared based on (1) the area under the ROC (receiver operating characteristic) curve (AUC), (2) the calibration slope and the intercept, and (3) the Brier score. Results: There were 1,822 patients included in this study: 170 patients (9%) developed an infection that required treatment, 62 patients (3%) received nonoperative treatment with oral or intravenous antibiotics, and 108 patients (6%) underwent subsequent surgery in addition to antibiotic therapy. Random forest algorithms identified 7 variables that were relevant for predicting infection: (1) Gustilo-Anderson or Tscherne classification, (2) bone loss, (3) mechanism of injury, (4) multitrauma, (5) AO/OTA fracture classification, (6) age, and (7) fracture location. Training of the penalized logistic regression algorithm resulted in the best-performing prediction model, with AUC, calibration slope, calibration intercept, and Brier scores of 0.75, 0.94, 0.00, and 0.076, respectively, in the derivation cohort and 0.81, 1.07, 0.09, and 0.079, respectively, in the validation cohort. Conclusions: We developed an ML prediction model that can estimate the probability of infection for individual patients with TSFs based on patient and fracture characteristics that are readily available at hospital admission.

Acute pain is one of the most common symptoms shared among patients who have suffered from an orthopedic trauma such as an isolated upper limb fracture (IULF). Development of interventions with lim...

Objective Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper limb fracture (IULF) in relation to pain intensity. Methods Eighty-four (56 IULF patients < 14 days post-trauma and 28 healthy controls). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). A single transcranial magnetic stimulation (TMS) session was performed over M1 to compare groups on resting motor threshold (rMT), short-intracortical inhibition (SICI), intracortical facilitation (ICF), and long-interval cortical inhibition (LICI). Results Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. Discussion These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.

This literature review investigated the subtle cavovarus foot with a search in Pubmed and Google Scholar using the following keywords: Subtle cavovarus foot, cavovarus foot or cavus foot and one or more of the following: Associations, injuries, ankle sprains, ankle instability, sports, plantar pressure, dynamic pedobarography, Tekscan and footprint, from January 1980 to February 2019. Subtle cavovarus foot can alter foot and ankle biomechanics but reference values are lacking for dynamic pedobarography assessment. Subtle cavovarus foot is associated with peroneal tendinopathy, metatarsal stress fractures, and recurrent lateral ankle sprains, potentially leading to chronic ankle instability due to altered walking central control patterns. Treatment includes flexible/semi-rigid orthotics to laterally offload the foot, or surgery in rigid cases. Subtle cavovarus foot is associated with chronic foot and ankle pathologies. Unfortunately, diagnosis is often difficult or delayed. Early conservative management, with appropriate foot orthotics, favors a safer return to sports. Strength of Recommendation Taxonomy (SORT): B Level of evidence: Level IV clinical review

This study aimed to evaluate the clinical outcomes of paediatric patients who underwent a retrograde drilling treatment for their osteochondritis dissecans (OCD) of the talus. The secondary purpose...

OBJECTIVES:Intra-articular screw cut-out is a common complication after proximal humerus fracture (PHF) fixation using a locking plate. This study investigates novel technical factors associated with mechanical failures and complications in PHF fixation.DESIGN:A retrospective radiological study.SETTING:Level 1 trauma center.PATIENTS/PARTICIPANTS:Clinical and radiological data from consecutive PHF patients treated between January 2007 and December 2013 were reviewed.INTERVENTION:Open reduction and internal fixation with the Synthes Philos locking plate.MAIN OUTCOME MEASUREMENTS:Postoperative radiographs were assessed for quality of initial reduction, humeral head offset, screw length, number and position, restoration of medial calcar support or the presence of calcar screws, and intra-articular screw perforations. Using SliceOMatic software, we validated a method to accurately identify screws of 45 mm or longer on AP radiographs. Follow-up radiographs were reviewed for complications.RESULTS:Among 110 patients included [mean age 60 years, 78 women (71%), follow-up 2.5 years] and the following factors were associated with a worse outcome. (1) Screws >45 mm in proximal rows [Odds Ratio (OR) = 5.3 for screw cut-out); (2) lateral translation of the humeral diaphysis over 6 mm (OR = 2.7 for loss of reduction); (3) lack in medial support by bone contact (OR = 4.9 for screw cut-out); (4) varus reduction increased the risk of complications (OR = 4.3).CONCLUSION:The importance of reduction and calcar support in PHF fixation is critical. This study highlights some technical factors to which the surgeon must pay attention: avoid varus reduction, maximize medial support, avoid screws longer than 45 mm in the proximal rows, and restore the humeral offset within 6 mm or less.LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND The ideal approach for a total hip arthroplasty (THA) would be kind to soft tissues, have the lowest complication rates and be easily reproducible. Although there have been several attempts to find the best approach for THA in the last decade, a definitive answer has not been found. We performed a prospective study to compare the direct anterior and posterior approaches for THA in terms of hospital length of stay, functional outcome, pain, implant position, complications and surgical time. METHODS A prospective, randomized, multicentre clinical study was conducted between February 2011 and July 2013, with an average follow-up of 55 months. Patients undergoing the direct anterior or posterior approach for THA were enrolled. Hospital length of stay, surgical time and complications were documented. The Harris Hip Score and visual analogue scale were used to monitor functional outcome and pain until 5 years postoperatively. Radiologic analysis was used to assess implant position. RESULTS Fifty-five patients (28 undergoing the direct anterior approach, 27 undergoing the posterior approach) were enrolled in this study. Length of stay, functional outcome, pain, implant position and complications were similar for the 2 approaches. There was a trend toward a better functional outcome for patients who underwent the direct anterior approach in the first 3 months postoperatively, with a peak at 4 weeks (Harris Hip Score 76.7 v. 68.7; p = 0.08). Average surgical time for the direct anterior approach was significantly longer (69.9 v. 45.7 min; p = 0.002). CONCLUSION The direct anterior approach for THA appears to be a safe and effective option. However, there is no significant difference in hospital length of stay or postoperative recovery between the 2 approaches. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, no. NCT03673514.

Background: Different treatment options exist for dynamically unstable purely ligamentous syndesmotic injury, including surgery, walking boot, brace and taping. Objective: The main purpose of this study was to evaluate the effect of high-ankle sprain taping (ring taping) on syndesmotic stability in various ligament conditions when axial loading is applied. Methods: This controlled cadaveric laboratory study included ten cadaveric specimens installed in a custom-made device applying 750N of axial loading in order to simulate weight-bearing. Sectioning of syndesmotic ligaments, AiTFL and IOL, was done sequentially and CT scan images were taken with and without high-ankle sprain taping. A validated measurement system consisting of 3 lengths and 1 angle was used. Results were compared with Wilcoxon tests for paired samples and non-parametric data. Results: In every ligament condition (intact vs. cut), no statistically significant difference was observed between specimens, with or without high-ankle sprain taping and with or without axial loading. When the data from ankles with AiTFL and IOL ruptures were compared, the mean for length “b” without axial loading was 7.19 (±2.17), compared to 7.20 (±1.98) with axial loading (p-value = 0.905). With taping and the leg still in axial loading, the value was 7.17 (±2.09) (p-value = 0.721), which is not statistically significant. Conclusion: It is impossible to conclude regarding high-ankle sprain taping’s capacity to maintain syndesmosis congruity because no significant difference was observed, regardless of condition. The most important finding is that high-ankle sprain taping did not cause malreduction of the injured syndesmosis. Level of Evidence: Level V cadaveric study

Introduction Orthopaedic injuries affect almost 90% of trauma patients. A previous scoping review and expert consultation survey identified 15 potential low-value intra-hospital practices in the adult orthopaedic trauma population. Limiting the frequency of such practices could reduce adverse events, improve clinical outcomes and free up resources. The aim of this study is to synthesise the evidence on intra-hospital practices for orthopaedic injuries, previously identified as potentially of low value. Methods and analysis We will search Medline, Excerpta Medica Database (EMBASE), the Cochrane Central Register of Controlled Trials and Epistemonikos to identify systematic reviews, randomised controlled trials (RCTs), quasi-RCTs, cohort studies and case–control studies that evaluate selected practices according to a priori PICOS statements (Population–Intervention–Comparator–Outcome–Study design) . We will evaluate the methodological quality for systematic reviews using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2). Risk of bias in original studies will be evaluated with the Cochrane revised tool for RCTs (RoB2) and with the risk of bias in non-randomised studies of interventions (ROBINS-I) tool. If for a given practice, more than two original studies on our primary outcome are identified, we will conduct meta-analysis using a random effects model and assess heterogeneity using the I2 index. We will assess credibility of evidence (I–IV) based on statistical significance, sample size, heterogeneity and bias as per published criteria. Ethics and dissemination Ethics approval is not required as original data will not be collected. Knowledge users from three level I trauma centres are involved in the design and conduct of the study in accordance with an integrated knowledge translation approach. Findings related to the rapid review will be available in May 2020. They will be presented to key stakeholders to inform discussions and raise awareness on low-value injury care. In addition, results will be disseminated in a peer-reviewed journal, at national and international scientific meetings and to healthcare associations.

Background: This study aimed to compare the functional and clinical outcomes between the deltoid split (DS) approach and the classic deltopectoral (DP) approach for locking plate fixation of proximal humerus fractures (PHF) in a prospective randomized multicenter study. Methods: From 2007 to 2015, all patients with a PHF Neer II/III were invited to participate. Exclusion criteria were pre-existing pathology to the limb, patient refusing or too ill to undergo surgery, patient needing another type of treatment (nail, arthroplasty), and axillary nerve impairment. After consent, patients were randomized to one of the 2 treatments using the dark envelope method. Functional outcome was evaluated by validated questionnaires (12-Item Short Form Health Survey: version 2, Quick-DASH) with a minimum follow-up of 12 months. Complications were noted. Results: A total of 85 patients (44 DS, 41 DP) were randomized (mean age of 62). Groups were equivalent in terms of age, gender, body mass index, severity of fracture, and preinjury scores. The mean follow-up was 26 months. All clinical outcome measures were in favor of the deltopectoral approach. Specifically, the Q-DASH and SF-12v2 were better in the DP group (12 vs. 26, P=.003 and 56 vs. 51, P=.049, respectively). There were more complications in DS patients, but they did not reach statistical significance. Conclusions: The primary hypothesis on the superiority of the deltoid split incision was rebutted. On the basis of our study, the DP approach seems to offer better function compared with the DS approach for fixation of Neer 2 and 3 PHF fractures fixed with a locking plate. (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

To define the localization of the entry point of the lateral ascending branch of the anterior circumflex humeral artery (LACHA) for better surgical management and prevention of injury to this important vessel. The hypothesis is that the insertion point of the artery will be constant in subjects. A retrospective study of 27 tomographic images was conducted to generate a three-dimensional (3D) model and localize the entry point of the LACHA. Using a coordinate system consisting of three axes: the proximal–distal axis (PDA), the anterior–posterior axis (APA) and the medial–lateral axis (MLA), the position of a foramen located in the superior portion of the bicipital groove and representing the entry point of LACHA was measured on each reconstructed model. On average, the foramen was located 10.0 mm distal along the PDA from the most proximal point of the greater tuberosity (GT). Along the MLA and with respect to the most medial portion of the GT, the foramen was located 3.4 mm medially, on average. No significant differences between men and women or between sides for foramen position measurements were found. Unnecessary procedures to the proximal biceps, aiming to prevent chronic pain, should be avoided in fracture fixation as they would affect a significant source of blood supply to the humeral head. These findings could help surgeons protect the only vascular supply they can during the fixation of proximal humeral fractures, when using the anterior or antero-lateral approaches.

Objective Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper limb fracture (IULF) in relation to pain intensity. Methods Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls) performed a single transcranial magnetic stimulation (TMS) session over M1 (resting motor threshold (rMT); short-intracortical inhibition (SICI); intracortical facilitation (ICF); long-interval cortical inhibition (LICI)). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). Results Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. Discussion These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.

Objectives: We hypothesize that a single syndesmotic view, capturing both sagittal and coronal tibiofibular displacement, will be more sensitive than a mortise view to detect syndesmotic instability. Methods: Ten fresh frozen human lower limbs were used to test the new syndesmotic view with simulated syndesmosis injury. The anteroinferior tibiofibular ligament, interosseous membrane, and posteroinferior tibiofibular ligament were sectioned sequentially. At each stage, the syndesmosis was tested using the external rotation stress (ERS) test and lateral stress test (LST). For each stress condition, a true mortise view and the new syndesmotic view were performed. Medial clear space and tibiofibular clear space (TFCS) were measured on a mortise view, and TFCS was measured on a syndesmotic view (TFCS-s). Wilcoxon signed-rank tests were used to compare measurements. Results: Syndesmotic view enabled instability detection with a 2-ligament dissection at a mean increase in TFCS-s of 2.37 mm (P = 0.021) and 1.98 mm (P = 0.011), using the ERS and LST, respectively. TFCS on the mortise view was significantly different only with a complete injury. Medial clear space did not vary significantly with injury increments. Sensitivity was 66% and 61% using ERS and LST, respectively, for the TFCS-s, compared with 27% and 33%, respectively, for the TFCS. Specificity was similar for TFCS and TFCS-s. Conclusions: This study was able to demonstrate that the syndesmotic view is more sensitive than the mortise view in detecting syndesmotic instability in a cadaveric model. It is particularly helpful to uncover instability secondary to an incomplete syndesmosis injury requiring fixation.