Technical TrickOperative Setup to Improve Sagittal Syndesmotic Reduction Technical TipBoszczyk, Andrzej MD, PhD*; Kordasiewicz, Bartłomiej MD, PhD*; Kiciński, Maciej MD*; Fudalej, Marcin MD, PhD†; Rammelt, Stefan MD, PhD‡Author Information *Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Clinical Hospital, Otwock, Poland; †Forensic Medicine Department, Medical University of Warsaw, Warsaw, Poland; and ‡University Center for Orthopaedics & Traumatology, University Hospital, Dresden, Germany. Reprints: Andrzej Boszczyk, MD, PhD, Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Prof. Adam Gruca Clinical Hospital, Konarskiego St 13, Otwock, PL05-400, Poland (e-mail: email@example.com). S. Rammelt reports nonfinancial support from AO Trauma, outside the submitted work. The remaining authors report no conflict of interest. Ethical approval was granted on 19 October 2016 by Ethic Committee of The Medical Centre of Postgraduate Education. Accepted July 16, 2018 Journal of Orthopaedic Trauma: January 2019 - Volume 33 - Issue 1 - p e27-e30 doi: 10.1097/BOT.0000000000001310 Buy Metrics Abstract Summary: We analyzed the operative measures that may be used to reduce the likelihood of sagittal syndesmotic malreduction. Hence, we propose a simple technical tip to avoid sagittal plane malreduction of the fibula within the syndesmosis in ankle fractures. Supporting the leg under the heel should be avoided when performing syndesmotic reduction for unstable malleolar fractures, and support under the calf should be used instead. Our observations have been confirmed in 6 cadaver specimens. We observed that there was a significant anterior subluxation of the fibula when the leg was supported under the heel. No significant difference between the intact and unstable state was present when the leg was supported under the calf. In conclusion, during syndesmotic reduction and fixation in supine position, supporting the foot under the heel should be avoided. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.