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Review
. 2017 Mar;10(1):94-103.
doi: 10.1007/s12178-017-9389-4.

Current trends in the diagnosis and management of syndesmotic injury

Matthew L Vopat  1 , Bryan G Vopat  2 , Bart Lubberts  3 , Christopher W DiGiovanni  3
Affiliations
Review

Current trends in the diagnosis and management of syndesmotic injury

Matthew L Vopat et al. Curr Rev Musculoskelet Med. 2017 Mar.

Abstract

Ideal management of the various presentations of syndesmotic injury remains controversial to this day. High quality evidentiary science on this topic is rare, and numerous existing studies continue to contradict one another. The primary reasons for these discrepancies are that previous studies have failed to (1) properly distinguish between isolated (non-fractured) and non-isolated injuries, (2) accurately define stable from unstable injuries, and (3) sufficiently differentiate between acute and chronic injuries. The purpose of this review is to summarize today's body of literature regarding diagnosis and management of syndesmotic injury and discuss current trends and important future directions to optimize care of this very heterogeneous population.

Keywords: Ankle fracture; High ankle sprain; Syndesmosis; Syndesmotic injury.

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Conflict of interest statement

Conflict of interest

Matthew L. Vopat, Bryan G. Vopat, and Bart Lubberts declare that they have no conflict of interest.

Christopher W. DiGiovanni reports stock options with Wright Medical, Paragon 28, and CreOsso. He is a consultant for Wright Medical and Extremity Medical. He also reports royalties from Extremity Medical.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
A 23-year-old rugby player presented with 3 months of right ankle pain after an eversion injury. The weight bearing Mortise (a) and lateral (b) X-rays demonstrated no diastasis of the tibiofibular overlap or medial clear space. However, calcification of the syndesmosis is seen consistent with a prior syndesmotic injury. Clinical exam was consistent with syndesmotic instability, therefore a weight bearing CT was obtained. The axial cuts (c) demonstrate diastasis of the syndesmosis of the right ankle (on the left) when compared to the contralateral ankle indicative of an unstable syndesmosis
Fig. 2
Fig. 2
If comparative CT scanning is normal but there is still a high suspicion, further analysis can be performed by arthroscopic stress evaluation of the syndesmosis (a) in both the sagittal and coronal planes. A probe is placed to be able to determine the amount of diastasis in the coronal and sagittal plane when a cotton test is performed in both planes. However, values for the amount of diastasis needed to indicate syndesmotic instability have still not been validated
Fig. 3
Fig. 3
Mortise (a) and lateral (b) weight bearing x-rays 6 weeks after fixation of an isolated syndesmotic injury demonstrate maintenance of the syndesmosis reduction. The screws are placed divergent through a plate in order to maximize fixation strength. Three months after fixation the hardware was removed and the mortise (c) demonstrates maintenance of reduction
See this image and copyright information in PMC

References

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