The application of this test in a patient population is necessary for its validation. I recently had a case of an ankle fracture fixation with syndesmosis injury, after reading this article. I completed intraoperative stress testing for evaluation of the syndesmosis after plate fixation of the lateral malleolus using the manual stress test, Cotton test, and “tap test.” There was syndesmosis instability, and the “tap test” was the most obvious in terms of identifying the widening with a syndesmosis injury. A critique of the “tap test” is the availability of the tap. With most screw sets being self-drilling and self-tapping, the tap may not be in many sets, so one must plan ahead for use of this test.

I commend the authors for this study, and I supported their results in a clinical setting.

Lisa K. Cannada, MD, is an orthopaedic trauma surgeon. She has been in practice for 16 years and is active in multiple organizations.