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Chronische obere Sprunggelenkinstabilität

Bei nicht erkannter distaler Syndesmosenruptur und Malunion der Fibulaspitze

Chronic ankle joint instability

In unrecognized distal rupture of the syndosmosis and malunion of the distal fibula

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Zusammenfassung

Hintergrund

In der Akutphase ist es oft schwierig, eine Verletzung der distalen tibiofibularen Syndesmose richtig zu diagnostizieren. Wird die Diagnose verpasst, entsteht eine Inkongruenz im oberen Sprunggelenk mit pathologischer Außenrotation des Talus. Das Risiko einer möglichen vorzeitigen Arthrose ist dadurch deutlich erhöht.

Fallvorstellung

In unserem dargestellten Fall wurde bei einer jungen Patientin eine distale Syndesmosenruptur verspätet diagnostiziert.

Material und Methode

Selektive Literaturrecherche sowie Darstellung des eigenen Falls.

Ergebnisse

Die verkürzte Fibula sowie die chronische Instabilität der tibiofibularen Syndesmose wurden mit einer Verlängerungs-/Derotationsosteotomie und einer Rekonstruktion mit der Grazilissehne korrigiert. Hierdurch ließen sich die anatomischen Verhältnisse exakt rekonstruieren.

Schlussfolgerungen

Das posttraumatische Malalignment im Bereich des oberen Sprunggelenks ist mit einem hohen Risiko für sekundär degenerative Veränderungen verbunden. Im Verdachtsfall muss daher die Diagnose erzwungen werden, denn der anatomischen Reposition und Rekonstruktion der Stabilität wird große Bedeutung zugemessen.

Abstract

Background

It is often difficult in the acute phase to diagnose a lesion of the distal tibiofibular syndesmosis. If this lesion is overlooked, the patient will develop an incongruity of the upper ankle joint with a pathological external rotation of the talus. The risk of a possible premature arthritis is clearly increased.

Objectives

In this case study a distal rupture of the syndesmosis in a young patient was overlooked in the initial diagnostic work-up.

Methods

A search of the relevant literature and a case report.

Results

In the case described the shortened fibula and chronic instability of the tibiofibular syndesmosis were repaired with a lengthening and derotational osteotomy and reconstruction using the gracilis muscle tendon. Through this method an exact reconstruction of the normal anatomy could be achieved.

Conclusion

Posttraumatic misalignment in the ankle joint is associated with a high risk of secondary degenerative lesions. In cases with suspicion of a syndesmosis lesion, confirmation of the diagnosis is imperative so as to perform an anatomic repositioning and reconstruction of stability.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Michelitsch, Y.P. Acklin, K. Stoffel, H. Bereiter geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Kantonsspital Graubünden, Chur, Schweiz

    C. Michelitsch, Y.P. Acklin, K. Stoffel & H. Bereiter

  2. Spital Männedorf, Asylstr. 10, 8708, Männedorf, Schweiz

    C. Michelitsch

Authors
  1. C. Michelitsch
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  2. Y.P. Acklin
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  3. K. Stoffel
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  4. H. Bereiter
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Correspondence to C. Michelitsch.

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Michelitsch, C., Acklin, Y., Stoffel, K. et al. Chronische obere Sprunggelenkinstabilität. Orthopäde 43, 379–385 (2014). https://doi.org/10.1007/s00132-014-2268-4

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  • DOI: https://doi.org/10.1007/s00132-014-2268-4

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