Abstract
Injuries of the distal tibiofibular syndesmosis comprise approximately 1–18% of all ankle sprains and are involved in 10% of all ankle fractures.1 A low reported incidence may be due to poor sensitivity in identifying subtle widening of the syndesmosis on radiograph, as these injuries are often unnoticed in the absence of frank diastasis. Though they represent a low percentage of ankle injuries, syndesmotic injury is the single most predictive factor for long-term disability and chronic ankle pain regardless of grade.2 In athletes, syndesmosis injuries significantly increase the time to return to activity compared to lateral ankle sprains and can be a source of significant disability3
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Jensen SL, Andresen BK, Mencke S, et al. Epidemiology of ankle fractures. A prospective population-based study of 212 cases in Aalborg, Denmark. Acta Orthop Scand. 1998;69(1):48–50.
Gerber JP, Williams GN, Scoville CR, et al. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19(10):653–60.
Hopkinson WJ, St Pierre P, Ryan JB, et al. Syndesmosis sprains of the ankle. Foot Ankle. 1990;10(6):325–30.
Xenos JS, Hopkinson WJ, Mulligan ME, et al. The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am. 1995;77(6):847–56.
Ogilvie-Harris DJ, Reed SC, Hedman TP. Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints. Arthroscopy. 1994;10(5):558–60.
Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am. 1956;38-A(4):761–81.
Peter RE, Harrington RM, Henley MB, et al. Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques. J Orthop Trauma. 1994;8(3):215–9.
Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med. 1991;19(3):294–8.
Stuart MJ, Smith A. Injuries in Junior A ice hockey. A three-year prospective study. Am J Sports Med. 1995;23(4):458–61.
Beumer A, van Hemert WL, Swierstra BA, et al. A biomechanical evaluation of clinical stress tests for syndesmotic ankle instability. Foot Ankle Int. 2003;24(4):358–63.
Kiter E, Bozkurt M. The crossed-leg test for examination of ankle syndesmosis injuries. Foot Ankle Int. 2005;26(2):187–8.
Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. 2007;35(7):1197–207.
Nussbaum ED, Hosea TM, Sieler SD, et al. Prospective evaluation of syndesmotic ankle sprains without diastasis. Am J Sports Med. 2001;29(1):31–5.
Nielson JH, Gardner MJ, Peterson MG, et al. Radiographic measurements do not predict syndesmotic injury in ankle fractures: an MRI study. Clin Orthop Relat Res. 2005;436:216–21.
Ebraheim NA, Lu J, Yang H, et al. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18(11):693–8.
Oae K, Takao M, Naito K, et al. Injury of the tibiofibular syndesmosis: value of MR imaging for diagnosis. Radiology. 2003;227(1):155–61.
Jenkinson RJ, Sanders DW, Macleod MD, et al. Intraoperative diagnosis of syndesmosis injuries in external rotation ankle fractures. J Orthop Trauma. 2005;19(9):604–9.
Brosky T, Nyland J, Nitz A, et al. The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation. J Orthop Sports Phys Ther. 1995;21(4):197–205.
Hoiness P, Stromsoe K. Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomized study comparing two methods of syndesmosis fixation. J Orthop Trauma. 2004;18(6):331–7.
Ho JY, Ren Y, Kelikian A, et al. Mid-diaphyseal fibular fractures with syndesmotic disruption: should we plate the fibula? Foot Ankle Int. 2008;29(6):587–92.
Forsythe K, Freedman KB, Stover MD, et al. Comparison of a novel fiberwire-button construct versus metallic screw fixation in a syndesmotic injury model. Foot Ankle Int. 2008;29(1):49–54.
Cottom JM, Hyer CF, Philbin TM, et al. Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton to traditional screw fixation in 50 cases. J Foot Ankle Surg. 2009;48(6):620–30.
Thornes B, Shannon F, Guiney AM, et al. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005;431:207–12.
Miller AN, Paul O, Boraiah S, et al. Functional outcomes after syndesmotic screw fixation and removal. J Orthop Trauma. 2010;24(1):12–6.
Manjoo A, Sanders DW, Tieszer C, et al. Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal. J Orthop Trauma. 2010;24(1):2–6.
Bell DP, Wong MK. Syndesmotic screw fixation in Weber C ankle injuries – should the screw be removed before weight bearing? Injury. 2006;37(9):891–8.
Moore JA Jr, Shank JR, Morgan SJ, et al. Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal. Foot Ankle Int. 2006;27(8):567–72.
Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma. 2005;19(2):102–8.
Chissell HR, Jones J. The influence of a diastasis screw on the outcome of Weber type-C ankle fractures. J Bone Joint Surg Br. 1995;77(3):435–8.
Klitzman R, Zhao H, Zhang LQ, et al. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int. 2010;31(1):69–75.
Grass R, Rammelt S, Biewener A, et al. Peroneus longus ligamentoplasty for chronic instability of the distal tibiofibular syndesmosis. Foot Ankle Int. 2003;24(5):392–7.
Edwards GS Jr, DeLee JC. Ankle diastasis without fracture. Foot Ankle. 1984;4(6):305–12.
Endean T, King W, Martin R. Syndesmotic rupture without ankle fracture: a report of two cases in professional football players. J Am Podiatr Med Assoc. 2003;93(4):336–9.
Kennedy JG, Soffe KE, Dalla Vedova P, et al. Evaluation of the syndesmotic screw in low Weber C ankle fractures. J Orthop Trauma. 2000;14(5):359–66.
Brown KW, Morrison WB, Schweitzer ME, et al. MRI findings associated with distal tibiofibular syndesmosis injury. AJR Am J Roentgenol. 2004;182(1):131–6.
Stoffe K, Wysocki D, Baddour E, et al. Comparison of two Intraoperative assessment methods for injuries to the ankle syndesmosis: a cadaveric study. J Bone Joint Surg Am. 2009;91:2646–52.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag London
About this chapter
Cite this chapter
Liu, G.T., Allen, M.A. (2013). Syndesmosis Injuries. In: Saxena, A. (eds) Sports Medicine and Arthroscopic Surgery of the Foot and Ankle. Springer, London. https://doi.org/10.1007/978-1-4471-4106-8_10
Download citation
DOI: https://doi.org/10.1007/978-1-4471-4106-8_10
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-4105-1
Online ISBN: 978-1-4471-4106-8
eBook Packages: MedicineMedicine (R0)