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specifically pertaining to the management of distal syndesmosis injuries in rotationally unstable ankle fractures continues to evolve. This is due to the realization that the rate of syndesmosis malreduction has been unacceptably high in the past. The
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MRI has a near-100% specificity in all cases of syndesmotic injury with high inter-observer agreement. 17 MRI displays the structures of the syndesmosis and allows for the grading of ligamentous injuries ( Table 1 ). 12 Table 1. Grading
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. Syndesmosis instability Isolated syndesmosis injuries, commonly referred to as high ankle sprains, are relatively uncommon. 31 They are usually associated with other lesions of the lateral ankle ligaments and are present in up to 20% of all ankle
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are considered unstable injuries ( Fig. 1 ). Fig. 1 The foot is supinated while external rotation (arrow) causes injury to the anterior syndesmosis (1) and a trans-syndesmotic distal fibular fracture (2). This is classified as a SER 2 fracture
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exclusion criteria. Population Adult patients (≥19 years) who had suffered an acute (<6 weeks), unstable syndesmotic injury Syndesmotic injury was defined as a ligamentous or bony avulsion injury (AiTFL or PiTFL) to the syndesmosis
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). 3 , 6 – 11 However, injury may not be confined to the lateral ligament complex and may extend to the subtalar, transverse, syndesmosis and/or medial side of the ankle. 7 Thus, involvement of the interosseous, cervical, bifurcate, tibiofibular
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PTFL injury does not occur unless the ankle joint undergoes dislocation. 28 A hyperdorsiflexion trauma might cause damage to the syndesmosis and an eversion injury will cause injury to the deltoid ligaments. 29 Fig. 6 Inversion of the
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Introduction Isolated injuries to the syndesmotic complex occur in approximately 1–17% of all ankle sprains ( 1 , 2 ) and in up to 30% in high-impact sports ( 3 ). Furthermore, the syndesmosis is injured in up to 13% of all ankle fractures
Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
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AO Research Institute Davos, Davos Switzerland
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-wire. There are different possible approaches depending on the fracture pattern. In patients with osteoporotic bone, bone avulsions of the tibiofibular syndesmosis are more likely than a ligamentous injury of the syndesmosis ( 53 ). Anatomical reduction and
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ligament ruptures and isolated medial malleolar fractures without syndesmotic or lateral instability. Relevant injury to the tibio-fibular syndesmosis and/or deltoid ligament has to be ruled out by either stress or standing radiographs. 23 , 24
