Syndesmosis Sprains of the Ankle

Abstract

A retrospective review of the clinical records and radiographs of 1344 ankle sprains occurring over a 41-month period at the United States Military Academy was performed. The incidence and severity of these sprains did not differ significantly from other studies with the exception of those injuries involving the tibiofibular ligaments. Those patients sustaining incomplete injuries to the ankle syndesmosis had a recovery time of almost twice that of those patients with severe (3rd degree) ankle sprains (55 vs. 28 days). Eight of 13 patients with 10 of 15 incomplete syndesmosis injuries were available for follow-up examination and radiographs at an average time of 20 months postinjury (range of 7-39 months). All patients with this injury had a positive "squeeze test" (compression of the fibula to the tibia at mid-calf) at the time of initial examination. Nine of 10 patients developed ossification of the syndesmosis in follow-up radiographs. None of these patients had developed chronic ankle instability, loss of motion, or arthritic changes of the joint at the time of final followup.

Suture Button Fixation for Syndesmosis Injuries: Review of the Literature

“…Different from lateral ankle sprains, mechanism of injury mostly involves external rotation, eversion and excessive dorsiflexion [1,3]. Less commonly seen mechanisms are dorsiflexion with axial loading, eversion, inversion, plantar flexion, pronation and internal rotation [4,7,[13][14][15][16][17]. In most complete syndesmotic distruptions external rotation causes a Weber B or C fracture with syndesmosis widening [18,19].…”

“…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

“…Complete ligamentous injuries are rare without fracture but are generally repaired surgically [32•]. High ankle sprains are less common than "inversion" lateral ankle sprains, comprising around 10 % of all ankle sprains [15,34], but represent up to 25 % of ankle sprains in collision sports such as American football [16, 32•, 35]. As compared with inversion sprains, high ankle sprains are more likely to create long-term dysfunction [16] and require much more time for recovery [15,36].…”

Incidence of Ankle Arthritis in Syndesmotic Injuries Even after Operative Intervention

“…Syndesmotic disruption can occur in ankle injuries, with or without a fracture. In ankle fractures, syndesmotic get injured in about 50percent of Weber type B and in all Weber type C fractures, whereas in ankle sprains without fracture, syndesmotic disruption accounts for 1-11percent of all ankle trauma (2) . However, in discussing syndesmotic injury it seems the exact proximal and distal borders of the distal tibiofibular syndesmosis are not properly described.…”