title: An update on the evaluation and treatment of syndesmotic injuries.
abstract: BACKGROUND
  Injuries to the distal tibiofibular syndesmosis are frequent and continue to generate controversy.
  
  
  METHODS
  The majority of purely ligamentous injuries ("high ankle sprains") is not sassociated with a latent or frank tibiofibular diastasis and may be treated with an extended protocol of physical therapy. Relevant instability of the syndesmosis with diastasis results from rupture of two or more ligaments that require surgical stabilization. Syndesmosis disruptions are commonly associated with bony avulsions or malleolar fractures. Treatment consists in anatomic reduction of the distal fibula into the corresponding incisura of the distal tibia and stable fixation. Proposed means of fixation are refixation of bony syndesmotic avulsions, one or two tibiofibular screws and suture button. There is no consensus on how long to maintain fixation. Both syndesmotic screws and suture buttons need to be removed if symptomatic.
  The most frequent complication is syndesmotic malreduction and may be minimized with open reduction and intraoperative 3D scanning. Other complications include hardware failure, heterotopic ossification, tibiofibular synostosis, chronic instability and posttraumatic arthritis.
  
  
  CONCLUSIONS
  The single most important prognostic factor is anatomic reduction of the distal fibula into the tibial incisura.
authors.affiliation: University Center for Orthopaedics and Traumatology, University Hospital Carl-Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany. stefan.rammelt@uniklinikum-dresden.de.
authors.forename: S
authors.initials: S
authors.lastname: Rammelt
authors.affiliation: Department of Traumatology, Masarykova Nemocnice, Socíalní péče 3316/12A, 401 13, Ústí Nad Labem, Czech Republic. petr.obruba@kzcr.eu.
authors.forename: P
authors.initials: P
authors.lastname: Obruba
mesh_terms: D064386:Ankle Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016512:Ankle Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001696:Biomechanical Phenomena / Q000502:physiology; D001863:Bone Screws; D020878:Device Removal; D005360:Fibula / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D007593:Joint Instability / Q000503:physiopathology / Q000517:prevention & control; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D010808:Physical Examination / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D012421:Rupture / Q000601:surgery; D013536:Suture Techniques; D013977:Tibia / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000209:etiology
keywords: Ankle; Fixation; Instability; Syndesmosis; Treatment