J Korean Foot Ankle Soc.  2022 Jun;26(2):95-102. 10.14193/jkfas.2022.26.2.95.

Current Trends in the Treatment of Syndesmotic Injury: Analysis of the Korean Foot and Ankle Society (KFAS) Member Survey

  • 1Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
  • 2Department of Orthopedic Surgery, Chungbuk National University Hospital, Cheongju, Korea
  • 3Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
  • 4Department of Orthopedic Surgery, The Catholic University of Korea, Bucheon St. Mary’s Hospital, Bucheon, Korea
  • 5Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea


This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades.
Materials and Methods
A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency.
Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis.
This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries.


Ankle; Syndesmotic injury; Trends; Survey; Korean Foot and Ankle Society


  • Figure. 1 Preferred method to diagnose syndesmotic injury (choose up to 3). MRI: magnetic resonance imaging, CT: computed tomography.

  • Figure. 2 Preferred intra-operative diagnostic method to diagnose syndesmotic diastasis (choose up to 2).

  • Figure. 3 Preferred fixation device syndesmotic injury. (A) Without ankle fracture; (B) with ankle fracture; (C) Maisonneuve fracture. AITFL: anterior inferior tibiofibular ligament.

  • Figure. 4 Preferred reduction and fixation methods. (A) Reduction method, (B) fixation level (proximal from ankle joint), (C) ankle position during fixation.

  • Figure. 5 Factors to select suture button fixation (choose up to 3). DM: diabetes mellitus.

  • Figure. 6 Factors that affect poor prognosis (choose up to 3).

  • Figure. 7 Treatment for a neglected syndesmotic injury.


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