Skip to main content
Log in

Computed tomography of normal distal tibiofibular syndesmosis

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study was to determine the shape and measurements of the normal distal tibiofibular syndesmosis on computed tomographic scans and to identify features that could aid in the diagnosis of syndesmotic diastasis using computed tomography (CT).

Materials and methods

CT scans of 100 patients with normal distal tibiofibular syndesmoses were reviewed retrospectively. In 67% the incisura fibularis was deep, giving the syndesmosis a crescent shape. In 33% the incisura fibularis was shallow, giving the syndesmosis a rectangular shape. The measurements of both types were taken using the same reference points.

Results

The mean age of the patients was 40 years, and there were 53 men and 47 women. The mean width of the distal tibiofibular syndesmosis anteriorly between the tip of the anterior tibial tubercle and the nearest point of the fibula was 2 mm. The mean width of the distal tibiofibular syndesmosis posteriorly between the medial border of the fibula and the nearest point of the lateral border of the posterior tibial tubercle was 4 mm. In men the mean width of the distal tibiofibular syndesmosis, anterior and posterior, was 2 mm and 5 mm, respectively, and in women it was 2 mm and 4 mm, respectively.

Conclusion

This study provides measurements of the normal tibiofibular syndesmosis to aid in the diagnosis of occult diastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ashhurst APC, Bromer RS. Classification and mechanism of fractures of the leg bones involving the ankle. Based on a study of three hundred cases from the Episcopal Hospital. Arch Surg. 1922;4:51–129.

    Google Scholar 

  2. Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am. 1956;38:761–81.

    PubMed  Google Scholar 

  3. Joy G, Patzakis MJ, Harvey JP Jr. Precise evaluation of the reduction of severe ankle fractures: technique and correlation with end results. J Bone Joint Surg Am. 1974;56:979–93.

    CAS  PubMed  Google Scholar 

  4. Sclafani SJ. Ligamentous injury of the lower tibiofibular syndesmosis: radiographic evidence. Radiology. 1985;156:21–7.

    CAS  PubMed  Google Scholar 

  5. Stiehl JB. Ankle fractures with diastasis. In: Greene WB (editor). Instructional course lectures. Park Ridge, IL: The American Academy of Orthopaedic Surgeons; 1990. pp. 95–103.

  6. Stiehl JB. Complex ankle fracture dislocations with syndesmotic diastasis. Orthop Rev. 1990;19:499–507.

    CAS  PubMed  Google Scholar 

  7. Edwards GS, De Lee JC. Ankle diastasis without fracture. Foot Ankle Int. 1984;4:305–12.

    Google Scholar 

  8. Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle Int. 1990;10:325–30.

    Google Scholar 

  9. Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18:693–8.

    CAS  PubMed  Google Scholar 

  10. Fritschy D. An unusual ankle injury in top skiers. Am J Sports Med. 1989;17:282–6.

    Article  CAS  PubMed  Google Scholar 

  11. Lovell ES. An unusual rotary injury of the ankle. J Bone Joint Surg Am. 1968;50:163–5.

    Google Scholar 

  12. Marymont JV, Lynch MA, Henning CE. Acute ligamentous diastasis of the ankle without fracture: evaluation by radionuclide imaging. Am J Sports Med. 1986;14:407–9.

    Article  CAS  PubMed  Google Scholar 

  13. Olerud S. Subluxation of the ankle without fracture of the fibula: a case report. J Bone Joint Surg Am. 1971;53:594–6.

    CAS  PubMed  Google Scholar 

  14. Wilson MJ, Michele AA, Jacobsen EW. Ankle dislocations without fracture. J Bone Joint Surg Am. 1939;21:198–204.

    Google Scholar 

  15. Cedell CA. Ankle lesions. Acta Orthop Scand. 1975;46:425–45.

    CAS  PubMed  Google Scholar 

  16. Harper MC. An anatomic and radiologic investigation of the tibiofibular clear space. Foot Ankle Int. 1993;14:455–8.

    CAS  Google Scholar 

  17. Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe L. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am. 1983;65:668–77.

    Google Scholar 

  18. Phillips WA, Schwartz HS, Keller CS, et al. A prospective randomized study of the management of severe ankle fractures. J Bone Joint Surg Am. 1985;67:67–78.

    CAS  PubMed  Google Scholar 

  19. Hamilton WJ. Locomotor system. Textbook of human anatomy. 2nd ed. Saint Louis, MO: Mosby; 1976. pp. 125–126.

  20. Williams PL, Warwick R, Dyson M, Bannister LH. Osteology. Gray’s anatomy. 37th ed. Edinburgh: Churchill Livingstone; 1989. pp. 446–447.

  21. Wuest TK. Injuries to the distal lower extremity syndesmosis. J Am Acad Orthop Surg. 1997;5:172–81.

    PubMed  Google Scholar 

  22. Leeds HC, Ehrlich MG. Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am. 1950;66:490–503.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hossein Elgafy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elgafy, H., Semaan, H.B., Blessinger, B. et al. Computed tomography of normal distal tibiofibular syndesmosis. Skeletal Radiol 39, 559–564 (2010). https://doi.org/10.1007/s00256-009-0809-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-009-0809-4

Keywords

Navigation