J Korean Foot Ankle Soc.  2022 Mar;26(1):9-15. 10.14193/jkfas.2022.26.1.9.

Syndesmotic Injury

• Ahn J
• Park MS
• Jeong BO

• KMID: 2527006
• DOI: http://doi.org/10.14193/jkfas.2022.26.1.9

Abstract

Syndesmotic injuries are found frequently in clinical practice, and they remain controversial because of the variety of diagnostic techniques and management options. Bony avulsions or malleolar fractures are commonly associated with syndesmotic disruptions. Even unstable isolated syndesmosis injuries are associated with a latent or frank tibiofibular diastasis and should not be ignored in the early phase. A relevant instability of the syndesmosis with diastasis results from collateral ligaments tears and requires operative stabilization.The treatment involves an anatomic reduction of the distal tibiofibular articulations followed by stable fixation. Syndesmotic transfixation screws or suture button implants are being proposed as a means of fixation. Recently, suture button fixation has shown more favorable outcomes, but the outcomes can still be controversial. Syndesmotic malreduction can lead to hardware failure, adhesions, heterotopic ossification, tibiofibular synostosis, chronic instability, and posttraumatic arthritis. In particular, the correct diagnosis and evidencebased treatment options for unstable syndesmotic injury should be considered.

Keyword

Ankle injury; Collateral ligament; Open fracture reduction; Fracture fixation

Figure

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  Figure. 1 (A) Squeeze test performed by compressing fibula to tibia above midpoint of calf. (B, C) External rotation test, the patient is seated with the hip and knees flexed to 90 degrees. One hand of the examiner is used to immobilize the lower leg and the other hand is used to rotate the foot outward. (D) Cross leg test position. In this test, when a force is applied to the medial side of the knee and pain occurs in the syndesmosis area, syndesmosis injury may be suspected.

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  Figure. 2 Radiographic relationships important in evaluating tibiofibular articulation. A: Tibiofibular clear space, B: tibiofibular overlap, C: medial clear space.

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  Figure. 3 (A) T1- and T2-weighted magnetic resonance images of syndesmotic injury around ankle joint level showing edema and ruptured pattern of anterior inferior tibiofibular ligament (arrows). Axial view (B) and coronal view (C) of more proximal area showing disruption of the interosseous membrane disruption (arrows).

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