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Biomechanics and Joint Replacement of the Foot and Ankle
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Rohit Madhav, Amit Amin, Deborah Eastwood, Dishan Singh
The distal tibiofibular syndesmosis is held together by the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament, the interosseus ligament and transverse tibiofibular ligaments. With ankle dorsiflexion, the wider anterior talus engages within the mortise, relying on some opening within the syndesmosis, typically about 2 mm. Isolated syndesmotic sprains (high ankle sprains) and a variety of ankle fractures can result in syndesmotic injury. Malreduction of the syndesmosis and instability have been shown to increase ankle joint contact pressures and may result in long-term predisposition to osteoarthritis.
Foot and ankle
Published in Pankaj Sharma, Nicola Maffulli, Practice Questions in Trauma and Orthopaedics for the FRCS, 2017
Pankaj Sharma, Nicola Maffulli
The ankle syndesmosis stabilises the distal tibia and fibula. Structures connecting the distal tibia and fibula are components of the ankle syndesmosis. The deltoid ligament connects the medial malleolus to the navicular and the talus, and is therefore not a component of the ankle syndesmosis.
Ankle Fracture
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
The key to managing this injury is recognition of the syndesmosis injury. The syndesmosis requires particular care given the high rate of malreduction reported in the literature, with rates of over 50% reported (on postoperative CT scans). If the fibula can be reduced anatomically, the length and rotation of the fibula will be such that the syndesmosis is reduced and can be fixed in situ. My preferred method of fixation would be with a single small fragment (3.5 mm) screw, placed through three cortices, with no plan to remove the screw. The patient would be treated in a below knee cast, non-weight bearing for approximately 8 weeks.
Defining the contemporary epidemiology and return to play for high ankle sprains in the National Football League
Published in The Physician and Sportsmedicine, 2022
Steven F. DeFroda, Blake M. Bodendorfer, Davis A. Hartnett, John D. Milner, Daniel S. Yang, Zachary S. Silber, Brian Forsythe
Ankle sprains are one of the most prevalent injuries in the National Football League (NFL), second only to knee injuries [1]. High ankle sprains, or syndesmotic injuries, are notorious in professional football players. They take longer to heal than low ankle sprains, leading to prolonged disability and missed playing time [2]. These injuries affect the distal tibiofibular syndesmosis, which is comprised of the anterior-inferior tibiofibular ligament (AITFL), interosseus ligament (IOL), posterior-inferior tibiofibular ligament (PITFL), and inferior transverse ligament [2]. The deltoid ligament confers stability by restricting lateral talar translation, which is often an accompanying injury to syndesmotic injuries [3]. High ankle sprains are more common in high-impact sports, such as football, rugby, or hockey, and remain a persistent source of missed playing time amongst elite athletes [4]. The injury typically results from forced dorsiflexion and external rotation of the foot relative to the ankle and tibia.
Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years
Published in Acta Orthopaedica, 2020
Benedikte Wendt Ræder, Ingrid Kvello Stake, Jan Erik Madsen, Frede Frihagen, Silje Berild Jacobsen, Mette Renate Andersen, Wender Figved
Plain radiographs of the injured ankle were obtained after surgery, and at 6 weeks and 6 months. CT scans of both ankles were obtained postoperatively, and after 1 and 2 years. CT scans were standardized with the patient in a supine position, placing the feet in a purpose-made device, keeping the ankles in neutral position with 20° internal rotation of the legs. Radiological measurements were performed by 1 senior musculoskeletal radiologist (SBJ) and one orthopedic surgeon (BWR). The syndesmosis was assessed postoperatively and after 1 and 2 years by measuring the tibiofibular distance on axial CT scans, 1 cm proximal to the midpoint of the tibial plafond (Figure 2). The difference between injured and uninjured side was calculated. A criterion of < 2 mm difference in tibiofibular distance was selected for acceptable syndesmotic reduction (Andersen et al 2019, Patel et al. 2019). Signs of ankle osteoarthritis (OA), synostosis, talar exostoses, broken screws, and osteochondral lesions were reported. When assessing OA on CT scans, we defined mild OA as presence of osteophytes, and advanced OA as narrowing of the joint space and presence of cysts and sclerosis (Ray et al. 2019).
Reduced incidence and economic cost of hardware removal after ankle fracture surgery: a 20-year nationwide registry study
Published in Acta Orthopaedica, 2020
Nikke Partio, Tuomas T Huttunen, Heikki M Mäenpää, Ville M Mattila
Approximately 10% of all ankle fractures have concomitant syndesmotic injury. In 15–23% of operatively treated ankle fractures, a syndesmotic disruption necessitates surgical repair with a syndesmotic screw (Jensen et al. 1998, Egol et al. 2010). However, the need to remove this screw remains controversial. In his literature review in 2011 (including 7 studies between 2000 and 2010), Schepers (2011) reported that there is no need to routinely remove the syndesmotic screws. In a recent systematic review, Dingemans et al. (2016) also suggest that the current literature does not support the routine removal of syndesmotic screws. Furthermore, the complication rate for routine syndesmotic screw removal is about 20% (Schepers et al. 2011). Fenelon et al. (2019) showed in their study that 6% of all patients underwent planned hardware removal and that the majority of procedures were for the removal of a syndesmosis screw after a median time of 3 months. Our register study could not separate all hardware removals from only syndesmotic screw removal, but we assume that most removals within 3 months were of syndesmotic screws. This assumption is supported by the fact that these procedures decreased markedly between 2011 and 2016, most likely due to the changed evidence suggesting syndesmotic screws need not be removed (Figure) (Schepers 2011).