Injuries to the tibiofibular syndesmosis

Abstract

The management of injury to the distal tibiofibular syndesmosis remains controversial in the treatment of ankle fractures. Operative fixation usually involves the insertion of a metallic diastasis screw. There are a variety of options for the position and characterisation of the screw, the type of cortical fixation, and whether the screw should be removed prior to weight-bearing. This paper reviews the relevant anatomy, the clinical and radiological diagnosis and the mechanism of trauma and alternative methods of treatment for injuries to the syndesmosis.

Suture Button Fixation for Syndesmosis Injuries: Review of the Literature

“…Failure of two of these ligaments leads to mechanical laxity of syndesmosis [2,3,8,10,11]. Syndesmosis widens 1.5 mm physiologically while ankle dorsiflexion [8]. It is showed that failure of total PITFL leads the most syndesmosis widening among other ligaments [10,12].…”

“…Deep portion provides 33% and superficial portion provides 9% of ankle stability. Failure of two of these ligaments leads to mechanical laxity of syndesmosis [2,3,8,10,11]. Syndesmosis widens 1.5 mm physiologically while ankle dorsiflexion [8].…”

“…It is less frequently seen than lateral ankle injuries [3]. The incidence differs between 1% to 18% in different studies [4][5][6][7][8][9].…”

Syndesmosis injuries

“…Wei et al [11]showed that ankle external rotation with an everted foot is also more likely to disrupt the AITFL, first producing lateral translation and external rotation of the talus. Conversely, external rotation of a neutral foot is more likely to initially result in deltoid ligament injury [11], with subsequent injury to the AITFL and syndesmotic ligaments [12]. Disruption of at least two lateral ligaments and injury to the deltoid ligament are necessary for complete syndesmosis instability.…”

“…Approximately one in seven ankle fractures are associated with an injury to the syndesmosis [12]. Rotational ankle injuries can result in particularly high mechanical forces when they occur in high-impact and collision activities, especially when they occur at high speeds and in patients with high body mass index.…”