Evaluation of the Fibular Incisura of the Tibia with Magnetic Resonance Imaging

A syndesmosis is defined as a fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments. This definition also applies for the distal tibiofibular syndesmosis, which is a syndesmotic joint formed by two bones and four ligaments. The distal tibia and fibula form the osseous part of the syndesmosis and are linked by the distal anterior tibiofibular ligament, the distal posterior tibiofibular ligament, the transverse ligament and the interosseous ligament. Although the syndesmosis is a joint, in the literature the term syndesmotic injury is used to describe injury of the syndesmotic ligaments. In an estimated 1-11% of all ankle sprains, injury of the distal tibiofibular syndesmosis occurs. Forty percent of patients still have complaints of ankle instability 6 months after an ankle sprain. This could be due to widening of the ankle mortise as a result of increased length of the syndesmotic ligaments after acute ankle sprain. As widening of the ankle mortise by 1 mm decreases the contact area of the tibiotalar joint by 42%, this could lead to instability and hence early osteoarthritis of the tibiotalar joint. In fractures of the ankle, syndesmotic injury occurs in about 50% of type Weber B and in all of type Weber C fractures. However, in discussing syndesmotic injury, it seems the exact proximal and distal boundaries of the distal tibiofibular syndesmosis are not well defined. There is no clear statement in the Ashhurst and Bromer etiological, the LaugeHansen genetic or the Danis-Weber topographical fracture classification about the exact extent of the syndesmosis. This joint is also not clearly defined in anatomical textbooks, such as Lanz and Wachsmuth. Kelikian and Kelikian postulate that the distal tibiofibular joint begins at the level of origin of the tibiofibular ligaments from the tibia and ends where these ligaments insert into the fibular malleolus. As the syndesmosis of the ankle plays an important role in the stability of the talocrural joint, understanding of the exact anatomy of both the osseous and ligamentous structures is essential in interpreting plain radiographs, CT and MR images, in ankle arthroscopy and in therapeutic management. With this pictorial essay we try to fill the hiatus in anatomic knowledge and provide a detailed anatomic description of the syndesmotic bones with the incisura fibularis, the syndesmotic recess, synovial fold and tibiofibular contact zone and the four syndesmotic ligaments. Each section describes a separate syndesmotic structure, followed by its clinical relevance and discussion of remaining questions.

show abstract

“…Its depth varies from 1.0 to 7.5 mm (Grass, 2000; Sora et al. 2004) and is a little less in women than in men (Yildirim et al. 2003).…”

Section: Syndesmotic Bones and Incisura Fibularismentioning

confidence: 99%

Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Of the 152 articles, 10 evaluating 1050 IFs were found eligible 11,13,[17][18][19][20][21][22][23][24] and included in the current review ( Figure 1), with 60% of those published in the past 5 years. Furthermore, 60% of the studies published were from the United States, India, and Turkey.…”

Section: Resultsmentioning

confidence: 99%

Is Incisura Fibularis a Reliable Landmark for Assessing Syndesmotic Stability? A Systematic Review of Morphometric Studies

Prakash¹

2016

Foot & Ankle Specialist

View full text Add to dashboard Cite

show abstract

“…U ovim slučajevima sindezmoza poprima četverokutasti oblik 13,14 . Dubina varira od 1 mm do 7,5 mm i nešto je plića u žena 15,16 . Plitka incisura fibularis na tibiji predstavlja jedan od predisponirajućih čimbenika za recidivirajuće ozljede gležnja ili ozljede sindezmoze s frakturama 17,18 .…”

Section: Anatomijaunclassified

Sindezmoza gležnja

Gulan

Štiglić

Majić

et al. 2020

Med. Flum. (Online)

View full text Add to dashboard Cite

Distalni tibiofibularni zglob odgovoran je za širinu i stabilnost takozvane zglobne viljuške gležnja koju sačinjavaju distalna tibija i distalna fibula. Prema nekim autorima tijekom uganuća gležnja u 95 % slučajeva dolazi i do ozljede ligamenta distalnog tibiofibularnog zgloba. Upravo je prepoznavanje ovih ozljeda od velike važnosti, jer se pacijenti s tim ozljedama liječe dvostruko dulje od pacijenata s ozljedama ligamentarnih struktura lateralne strane gležnja, a do povratka sportskim aktivnostima protekne i do 6 mjeseci. Standardni klinički testovi i klasične rendgenske snimke nisu često dostatni za postavljanje dijagnoze, pa je pri sumnji na ozljede sindezmoze potrebno učiniti i magnetsku rezonanciju. Način liječenja akutnih izoliranih ozljeda sindezmoze ovisi o stupnju nestabilnosti gležnja. Danas još uvijek postoje nedoumice i nesuglasja u postavljanju dijagnoze i liječenja takvih ozljeda. U ovom radu pokušali smo na sistematičan način prikazati anatomske karakteristike distalnog tibiofibularnog zgloba, ali i najnovije stavove u dijagnostici i liječenju ozljede sindezmoze.

show abstract

Evaluation of the Fibular Incisura of the Tibia with Magnetic Resonance Imaging

Cited by 33 publications

References 13 publications

Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach

Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach

Is Incisura Fibularis a Reliable Landmark for Assessing Syndesmotic Stability? A Systematic Review of Morphometric Studies

Sindezmoza gležnja

Contact Info

Product

Resources

About