Management of syndesmotic injuries of the ankle (original) (raw)
Related papers
Evaluation and management of injuries of the tibiofibular syndesmosis
British Medical Bulletin, 2014
Introduction: Injury to the tibiofibular syndesmosis often arises from external rotation force acting on the foot leading to eversion of the talus within the ankle mortise and increased dorsiflexion or plantar flexion. Such injuries can present in the absence of a fracture. Therefore, diagnosis of these injuries can be challenging, and often stress radiographs are helpful. Magnetic resonance imaging scans can be a useful adjunct in doubtful cases. The management of syndesmotic injuries remains controversial, and there is no consensus on how to optimally fix syndesmosis. This article reviews the mechanism of injury, clinical features and investigations performed for syndesmotic injuries and brings the reader up-to-date with the current evidence in terms of the controversies surrounding the management of these injuries.
Management of distal tibio-fibular syndesmotic injuries : A snapshot of current practice
2008
Management of syndesmotic injuries of the ankle remains controversial. A postal questionnaire was administered to 310 Orthopaedic consultants in the United Kingdom to explore these issues. One hundred and ninety seven (63.55%) replies were received. A large number of surgeons use intra-operative hook test as an aid to assess syndesmotic stability (68.8%). A clear majority favoured the use of a syndesmotic screw as the preferred method of fixation (97.4%). The opinion on technique was divided over issues including number of cortices fixed, position and type of screw used. Most surgeons (88.4%) do not compress the syndesmosis while inserting the screw. Very few surgeons (8.5%) allow full weight bearing immediately after surgery. The survey establishes an overview of current practice of management of syndesmotic ankle injuries.
Paper 56: Distal Tibiofibular Syndesmosis Injuries Cause Multi-directional Ankle Instability
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
Introduction: Injury to the lateral ligaments of the ankle is one of the most common sports-related injuries. Chronic lateral instability of the ankle may occur in up to 30% of this population. The best surgical treatment for chronic instability remains controversial. The most widely used procedures (Watson-Jones, Evans and Chrisman and Snook), have a high rate of success, but have been criticized because they do not place the graft in an anatomical position, and cause a sub-talar stiffness. Objective: Describe a minimal invasive technique for the chronic lateral instability of the ankle, ensuring a long lasting fixation of the graft and respecting the subtalar joint. Materials and Methods: We describe a new minimal invasive technique for the lateral stabilization of the ankle. We performed this technique in 44 patients. We excluded patients with a history of a previous surgery of the ankle. Our patients were radiographically and clinically tested preoperatively and postoperatively following the Karlsson scale, and the telos measurement. All the procedures were performed by one surgeon. Our mean follow-up was 22.6 months Ϯ 9.768 months. All the results were analyzed with the SPSS 11.0 program. Results: We had 11 females and 33 males, with an average age of 31 years Ϯ 9.398 years. The average preoperative Karlsson scale was improved from 48.63 Ϯ 10.97 preoperative mean, to a postoperative mean of 86.34 Ϯ 16.827. From the radiographic point of view the telos has improved from a mean preoperative of 17.11 Ϯ 5.453 to 7.68Ϯ 4.142 postoperative. We found minor complications in eleven patients, 25%. The patient satisfaction was self-evaluated as excellent in 24 cases (54.5%), very good 12 (27.3%), good 7 (15.9%), moderate 1 case (2.3%), bad 0 (0%). Conclusion: The minimal invasive techniques allow us to perform important procedures with great respect to the anatomical structures, thus decreasing soft tissue complications, limiting the wound derived complications and improving postoperative cosmetic, and return to everyday activities.
Diagnosis and treatment of tibiofibular syndesmosis lesions
Orthopaedics & Traumatology: Surgery & Research, 2019
The tibiofibular syndesmosis is a fibrous joint essential for ankle stability, whence the classical comparison with a mortise. Syndesmosis lesions are quite frequent in ankle trauma. This is a key element in ankle stability and lesions may cause pain or instability and, in the longer term, osteoarthritis. The lesions are often overlooked due to diagnostic difficulties, but collision sport with strong contact is the main culprit. Diagnosis, whether in the acute or the chronic phase, is founded on an association of clinical and paraclinical signs. Cross-sectional imaging such as MRI is fundamental to confirming clinical suspicion. Absence of tibiofibular diastasis no longer rules out the diagnosis. Stress CT and the introduction of weight-bearing CT are promising future diagnostic tools. Exhaustive osteo-ligamentous ankle assessment is necessary, as syndesmosis lesions may be just one component in more complex rotational instability. Therapeutically, arthroscopy and new fixation techniques, such as suture buttons, are opening up new perspectives, especially for chronic lesions (> 6 months). The present anatomic, epidemiological, diagnostic and therapeutic review does not preclude further clinical studies of rotational ankle instability with its strong risk of osteoarthritis.
The anatomy and mechanisms of syndesmotic ankle sprains
Journal of athletic training
To present a comprehensive review of the anatomy, biomechanics, and mechanisms of tibiofibular syndesmosis ankle sprains. MEDLINE (1966-1998) and CINAHL (1982-1998) searches using the key words syndesmosis, tibiofibular, ankle injuries, and ankle injuries-etiology. Stability of the distal tibiofibular syndesmosis is necessary for proper functioning of the ankle and lower extremity. Much of the ankle's stability is provided by the mortise formed around the talus by the tibia and fibula. The anterior and posterior inferior tibiofibular ligaments, the interosseous ligament, and the interosseous membrane act to statically stabilize the joint. During dorsiflexion, the wider portion anteriorly more completely fills the mortise, and contact between the articular surfaces is maximal. The distal structures of the lower leg primarily prevent lateral displacement of the fibula and talus and maintain a stable mortise. A variety of mechanisms individually or combined can cause syndesmosis in...
Ankle syndesmosis: a qualitative and quantitative anatomic analysis
The American journal of sports medicine, 2015
Syndesmosis sprains can contribute to chronic pain and instability, which are often indications for surgical intervention. The literature lacks sufficient objective data detailing the complex anatomy and localized osseous landmarks essential for current surgical techniques. To qualitatively and quantitatively analyze the anatomy of the 3 syndesmotic ligaments with respect to surgically identifiable bony landmarks. Descriptive laboratory study. Sixteen ankle specimens were dissected to identify the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), interosseous tibiofibular ligament (ITFL), and bony anatomy. Ligament lengths, footprints, and orientations were measured in reference to bony landmarks by use of an anatomically based coordinate system and a 3-dimensional coordinate measuring device. The syndesmotic ligaments were identified in all specimens. The pyramidal-shaped ITFL was the broadest, originating from the distal interosseou...
High Ankle Sprains and Syndesmotic Injuries in Athletes
The Journal of the American Academy of Orthopaedic Surgeons, 2015
Treatment of athletes with ligamentous injuries of the tibiofibular syndesmosis can be problematic. The paucity of historic data on this topic has resulted in a lack of clear guidelines to aid in imaging and diagnosing the injury, assessing injury severity, and making management decisions. In recent years, research on this topic has included an abundance of epidemiologic, clinical, and basic science investigations of syndesmotic injuries that are purely ligamentous or associated with ankle fracture. Several classification systems can be used to classify ligamentous injury to the syndesmosis. These systems integrate clinical and radiographic findings but do not address the location of the injury or its severity. Injury to the syndesmosis can be purely ligamentous; however, many unstable syndesmotic injuries are associated with fractures. Nonsurgical management can be used for stable ligamentous injuries without frank diastasis, but surgical management, including screw or suture-butto...
Strategies in Trauma and Limb Reconstruction, 2012
Syndesmotic rupture is present in 10 % of ankle fractures and must be recognized and treated to prevent late complications. The method of fixation is classically rigid fixation with one or two screws. Knowledge of the biomechanics of the syndesmosis has led to the development of new dynamic implants to restore physiologic motion during walking. One of these implants is the suture-button system. The purpose of this paper is to review the orthopaedic trauma literature, both biomechanical and clinical, to present the current state of knowledge on the suture-button fixation and to put emphasis on the advantages and disadvantages of this technique. Two investigators searched the databases of Pubmed/Medline, Cochrane Clinical Trial Register and Embase independently. The search interval was from January 1980 to March 2011. The search keys comprised terms to identify articles on biomechanical and clinical issues of flexible fixation of syndesmotic ruptures. Ninetynine publications met the search criteria. After filtering using the exclusion criteria, 11 articles (five biomechanical and six clinical) were available for review. The biomechanical studies involved 90 cadaveric ankles. The suture-button demonstrated good resistance to axial and rotational loads (equivalent to screws) and resistance to failure. Physiologic motion of the syndesmosis was restored in all directions. The clinical studies (149 ankles) demonstrated good functional results using the AOFAS score, indicating faster rehabilitation with flexible fixation than with screws. There were few complications. Preliminary results from the current literature support the use of suture-button fixation for syndesmotic ruptures. This method seems secure and safe. As there is no strong evidence for its use, prospective randomized controlled trials to compare the suture-button to the screw fixation for ankle syndesmotic ruptures are required.