Scintigraphy of Injuries to the Distal Tibiofibular Syndesmosis

Abstract

Ankle sprains are a common injury and may occur in as many as 75% of sporting participants. More complex injuries involving a rotational component may lead to injury of the interosseous membrane, its supporting ligaments, or the tibial plafond, compromising the integrity of the ankle mortice. Four such cases that show the scintigraphic manifestation of the injury are presented. In addition to the standard planar views of the ankles, special magnified anterior views were obtained with the feet in internal rotation of 25 degrees to 35 degrees. These special views facilitated the diagnoses.

Diagnostic imaging of ankle syndesmosis injuries: A general review

“…Frater et al . have indicated that in some cases a nuclear medicine scan may be useful to assess ankle injuries that fail to heal.…”

Chronic instability of the anterior syndesmosis of the ankle

“…Several authors (Frater et al 2002, Marymont et al 1986) have assessed the value of bone-scintigraphy in ankles 1-5 weeks after a sprain. Trauma to the syndesmosis was indicated by focal activity at the syndesmosis or at the posterior edge of the tibial plafond consistent with avulsion of the posterior tibiofibular ligament, while interosseous membrane injury resulted in a linear area of increased activity at the distal lateral tibial border.…”

“…Radionuclide imaging is of no use in the assessment of syndesmotic instability or acute syndesmotic injuries, but it may show a band like activity over the interosseous ligament and membrane or a focal activity over the syndesmosis in chronic injuries (Frater et al 2002, Ogilvie-Harris et al 1997, Marymont et al 1986). …”

Scintigraphy of Benign Bone Disease

“…Late images show increased uptake in the posterior plafond (due to avulsion or chip fracture), medial edge of the posterior fibula (avulsion fracture), and extension of activity into the distal syndesmosis. 42 It may be associated with a fracture of the proximal fibula (Maisonneuve fracture).…”