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An update on the evaluation and treatment of syndesmotic injuries

  • Review Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Injuries to the distal tibiofibular syndesmosis are frequent and continue to generate controversy.

Methods

The majority of purely ligamentous injuries (“high ankle sprains”) is not sassociated with a latent or frank tibiofibular diastasis and may be treated with an extended protocol of physical therapy. Relevant instability of the syndesmosis with diastasis results from rupture of two or more ligaments that require surgical stabilization. Syndesmosis disruptions are commonly associated with bony avulsions or malleolar fractures. Treatment consists in anatomic reduction of the distal fibula into the corresponding incisura of the distal tibia and stable fixation. Proposed means of fixation are refixation of bony syndesmotic avulsions, one or two tibiofibular screws and suture button. There is no consensus on how long to maintain fixation. Both syndesmotic screws and suture buttons need to be removed if symptomatic.

Results/Complications

The most frequent complication is syndesmotic malreduction and may be minimized with open reduction and intraoperative 3D scanning. Other complications include hardware failure, heterotopic ossification, tibiofibular synostosis, chronic instability and posttraumatic arthritis.

Conclusion

The single most important prognostic factor is anatomic reduction of the distal fibula into the tibial incisura.

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Conflict of interest

Stefan Rammelt and Petr Obruba declare that they have no conflict of interest.

Compliance with ethical requirements

Stefan Rammelt and Petr Obruba declare that this is a review article that includes no studies on humans or animals. Therefore, an approval by an ethics committee was not applicable.

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  1. University Center for Orthopaedics and Traumatology, University Hospital Carl-Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany

    S. Rammelt

  2. Department of Traumatology, Masarykova Nemocnice, Socíalní péče 3316/12A, 401 13, Ústí Nad Labem, Czech Republic

    P. Obruba

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  1. S. Rammelt
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Rammelt, S., Obruba, P. An update on the evaluation and treatment of syndesmotic injuries. Eur J Trauma Emerg Surg 41, 601–614 (2015). https://doi.org/10.1007/s00068-014-0466-8

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