Syndesmosis

In several versions of " Introduction to Aristotle's Categories " (" The Isagoge ") we find very intriguing diagram of the "Tree of Porphyry". This diagram is closely linked with the square of opposition (logical square), natural tree with vegetative ornaments and the anthropomorphic figure. Porphyry took over Aristotle's division into five predicables (quinque praedicabilia) and defined them through five classes (species, genus, differentia, propria, accidentia) and from them he created scala praedicamentalis (Arbor Porphyriana). The Neoplatonic-Aristotelianism of Porphyry influenced the return of interest in Aristotle's logic in the Middle Ages through translations of Boethius and Al-Farabi. Their works of logic were the basis for the study of many topics, especially those related to theology. Later diagrams with the natural tree and human figure (syndesmos) are found in the 13th century in "Tractatus" (" Summulae Logicales ") written by Peter of Spain under different names such as: Tree of Love, Tree of Life, Tree of Science, Tree of Knowledge etc. Christian mysticism (Mystical theology), Islamic mysticism (Sufism) and Jewish mysticism (Kabbalah) was deeply influenced by Neoplatonic philosophy and within these mystical traditions we find different variations of the diagram aswell. Under the influence of the concept of Neoplatonic procession and reversion, mystic should be simultaneously involved in both Cataphatic and Apophatic theology to truly understand God. In other words, a spiritual person has to oscillate between affirming claims about the Tree of Life (the Being) and negation of those same claims to be able to have real knowledge of God.

U više verzija " Uvoda u Aristetolove kategorije " (" Isagog ") pronalazimo slikoviti prikaz dijagrama "Porfirijevog Drveta". Ovaj dijagram je povezivan sa kvadratom suprotnosti, figurom prirodnog drveta sa vegetativnim ornamentima, te sa antropomorfnom figurom. Porfirij je preuzeo Aristotelovu podjelu na pet predikabilija, te je od njih kreirao scala praedicamentalis (Arbor Porphyriana). Porfirijev neoplatonistički-aristotelizam doveo je u srednjem vijeku do povratka interesa za Aristotelovu logiku kroz prijevode Boethiusa i Al-Farabija. Njihova djela logike bila su temelj za proučavanje mnogih tema, pogotovo onih koje su se bavile teologijom. Kasnije prikaze dijagrama predstavljene simbolikom drveta sa vegetativnim ornamentima i ljudske figure (syndesmos) pronalazimo u 13 st. u " Traktatu " (" Summulae logicales ") Petra Španskog pod različitim imenima poput: Drvo Ljubavi, Drvo Plemenitosti, Drvo Nauke, Drvo Života, Drvo Znanja, Drvo Mudrosti itd. Kršćanski misticizam (mistična teologija), islamski misticizam (sufizam) i jevrejski misticizam (kabala) pod utjecajem neoplatonističke filozofije također sadrže različite varijante dijagrama "Drveta" unutar mnogih mističnih zajednica srednjovjekovnog svijeta. Pod utjecajem neoplatonističke procesije i reverzije, mistik treba biti istovremeno uključen u obje katafatičnu i apofatičnu teologiju kako bi uistinu razumio Boga. Drugim riječima, spiritualna osoba mora oscilirati između iznošenja tvrdnji o Drvetu Života (bitak) i negacije tih istih tvrdnji kako bi uistinu uhvatio srž spoznaje šta je to Bog.

Background
The lateral transmalleolar approach (LTA), a surgical approach for posterior malleolar fractures (PMFs), provides direct visualization of the articular surface of the posterior malleolus, though temporarily disrupting the syndesmosis. It is still unclear whether this fibrous joint can be effectively reconstructed afterward to prevent complications. We report the clinical results and computed tomography (CT) findings for articular and syndesmosis reduction status after surgery with LTA for PMF.
Methods
Sixteen patients who underwent PMF reduction with LTA with a follow-up of at least 1 year were evaluated retrospectively. Per the AO Foundation/Orthopaedic Trauma Association classification, the fracture type was 44B in 13 patients and 44C in three patients. The Haraguchi classifications of PMF were type 1 in six cases and type 2 in 10 cases. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score, post-surgical complications, and reduction status of PMF and syndesmosis on CT were investigated.
Results
The mean AOFAS score was 93.0 ± 5.2 points. Post-operative complications were observed in one case of superficial infection and one case of delayed fibular union. The articular step-off seen on CT improved significantly after surgery (5.9 ± 2.9 mm preoperatively vs. 0.6 ± 0.8 mm post-operatively). Syndesmosis malreduction was seen in three cases, including two high fibular fractures and one comminuted fibular fracture with osteoporosis.
Conclusions
The LTA provided favorable clinical results and effective reduction of intra-articular PMFs. However, surgeons should be aware of the possibility of syndesmosis malreduction in cases of high fibular fractures or comminuted fibular fractures.