Syndesmosis injuries involve the distal tibiofibular joint
and can disturb the regular strength of the ankle joint depending on their severity.
Stability in the distal tibiofibular joint is maintained by the syndesmotic ligaments, which include the anterior inferior tibiofibular ligament (AITFL), the posterior inferior tibiofibular ligament (PITFL), the transverse ligament, and the interosseous ligament.
The distal tibiofibular syndesmosis is disrupted when an injury forces apart the distal tibiofibular joint. The most commonly reported means of injury is external rotation with hyper-dorsiflexion of the ankle.
Intraoperative assessment of the stability of the distal tibiofibular joint
in supination-external rotation injuries of the ankle: Sensitivity, specificity, and reliability of two clinical tests.
These fractures may present with a rotational or bending element or with talus displacement into the distal tibiofibular joint. Either (or both) mechanisms cause syndesmotic displacement and soft-tissue injury.
The three-dimensional CT scanning reconstruction demonstrated displacement of the tibia and wedging of the talus into the distal tibiofibular joint (Figure 1(c)).
Numerous studies investigating the distal tibiofibular joint exist in the literature, yet there is no consensus regarding the definitive surgical treatment of acute syndesmosis injuries.
The bony architecture and the supporting syndesmotic ligaments stabilize the distal tibiofibular joint. The main function of the ligament complex is to maintain the integrity between the tibia and fibula, as well as resist axial, rotational, and translational forces.
The player was taped before every practice and game (lateral ankle restraint in addition to four circumferential strips proximal to the distal tibiofibular joint
) for the remainder of the season, and did not suffer re-injury or have persistent pain, swelling or loss of function.
With dorsiflexion of the foot, the distal tibiofibular joint
space widens to deepen the ankle mortise to accommodate the wider portion of the trapezoidal talus.
However, the syndesmotic bolt cannot permit a normal range of motion of the distal tibiofibular joint
, and tightrope technique lacks the ability of reducing the syndesmotic diastasis.
By using two separate incisions, 1 cm each at proximal and distal extent of proposed donor site, a segment of single fibula appropriate for the defect to be bridged was taken from a safe area of the bone without jeopardizing the associated neurovascular structures and proximal and distal tibiofibular joints
. The free nonvascularized autogenous fibular strut bone graft measured about 21 cm.