Fractures of the malleolus with syndesmotic injury : a challenge to diagnosis and treatment

  • Agrawal A.C. Professor & HOD Orthopaedics AIIMS, Raipur, CG, India
  • Sahoo B. Senior Resident
Keywords: posterior-inferior tibiofibular ligament (PITFL), anterior-inferior tibiofibular ligament (AITFL), distal tibiofibular

Abstract

Fractures of the malleolus associated with syndesmotic injuries are common. Diagnosis of the syndesmotic injury often is missed and requires stress testing. An initial stable syndesmosis on x-ray may get displaced in later x-ray and a high suspicion Index can prevent one from missing this injury. Figure 1 and 2. Accurate reduction and stable fixation of the syndesmosis are critical to outcomes. Unstable syndesmosis is particularly prone to malreduction including translation, rotation, and overcompression. Knowledge of the technical details regarding intraoperative reduction methods and reduction assessment can minimize the risk of syndesmotic malreduction and improve patient outcomes.

Downloads

Download data is not yet available.

References

Ogilvie-Harris DJ, Reed SC, Hedman TP: Disruption of the ankle syndesmosis: Biomechanical study of the ligamentous restraints. Arthroscopy 1994;10(5): 558560.

Hak DJ, Egol KA, Gardner MJ, Haskell A: The "not so simple" ankle fracture: Avoiding problems and pitfalls to improve patient outcomes. Instr Course Lect 2011;60:73-88.

Ebraheim NA, Lu J, Yang H, Rollins J: The fibular incisure of the tibia on CT scan: A cadaver study. Foot Ankle Int 1998;19(5): 318-321.

Beumer A, Valstar ER, Garling EH, et al: Kinematics of the distal tibiofibular syndesmosis: Radiostereometry in 11 normal ankles. Acta Orthop Scand 2003;74 (3):337-343.

Zalavras C, Thordarson D: Ankle syndesmotic injury. J Am Acad Orthop Surg 2007;15(6):330-339.

Young BH, Flanigan RM, DiGiovanni BF: Complications of ankle arthroscopy utilizing a contemporary noninvasive distraction technique. J Bone Joint Surg Am 2011;93(10):963-968.

Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG: Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int 2009;30 (5):419-426.

Marmor M, Hansen E, Han HK, Buckley J, Matityahu A: Limitations of standard fluoroscopy in detecting rotational malreduction of the syndesmosis in an ankle fracture model. Foot Ankle Int 2011; 32(6):616622.

Song DJ, Lanzi JT, Groth AT, et al: The effect of syndesmosis screw removal on the reduction of the distal tibiofibular joint: A prospective radiographic study. Foot Ankle Int 2014;35(6):543-548.
Published
2015-12-31
How to Cite
1.
Agrawal A.C., Sahoo B. Fractures of the malleolus with syndesmotic injury : a challenge to diagnosis and treatment. ojmpc [Internet]. 2015Dec.31 [cited 2024Apr.23];21(2):7-10. Available from: https://ojmpc.com/index.php/ojmpc/article/view/8
Section
Original Article