Acute syndesmotic injuries in ankle fractures: From diagnosis to treatment and current concepts

Abstract

A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship, and it is essential for normal motion of the ankle joint. The disruption of this joint is frequently accompanied by rotational ankle fracture, such as pronation-external rotation, and rarely occurs without ankle fracture. The diagnosis is not simple, and ideal management of the various presentations of syndesmotic injury remains controversial to this day. Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes. In such an injury, including inadequately treated, misdiagnosed and correctly diagnosed cases, a chronic pattern characterized by persistent ankle pain, function disability and early osteoarthritis can result. This paper reviews anatomical and biomechanical characteristics of this syndesmosis, the mechanism of its acute injury associated to fractures, radiological and arthroscopic diagnosis and surgical treatment.

Keywords: Ankle; Fracture; Injury; Distal tibiofibular joint; Trauma; Syndesmosis

Core Tip: Patients with unstable distal tibiofibular syndesmosis injuries associated with fractures require surgical stabilization. The aim of surgical treatment is to restore joint congruency and to maintain the stability of the syndesmosis until the ligaments have healed. Satisfactory results depend on correct management from diagnosis to treatment. Static and dynamic fixation systems have similar long-term clinical and radiological outcomes.