title: Variation of Syndesmosis Anatomy With Growth.
abstract: BACKGROUND
  Syndesmosis injury is common in trauma and in the sport medicine population. Diagnosis and treatment of this pathology is controversial in adult population and almost unknown in a growing and immature ankle. The objective of this study was to describe the relationship between the distal tibia and fibula in immature, growing, and mature children.
  
  
  METHODS
  A retrospective imaging study was performed on ankle magnetic resonance images (MRI), which were divided into 3 groups according to age: immature, growing, or mature. The syndesmosis anatomy was described in 3 planes following an established measurement system. The measurement system was also validated (intraobserver and interobserver reproducibility) on a subgroup of 30 MRIs with 4 surgeons.
  
  
  RESULTS
  The measurement system, previously described on CT scans, is valid when used on MRIs. The mediolateral translation significantly increases with growth and external rotation of fibula decreases. The anteroposterior position is also significantly different between groups but the ratios are similar.
  
  
  CONCLUSIONS
  This study reported differences in distal tibiofibular relationship in a growing population. This information will be crucial in future development of diagnostic and follow-up criteria of syndesmosis injury. It also presented a valid and precise measurement system to describe syndesmotic anatomy in 3 planes.
  
  
  METHODS
  Level IV.
authors.affiliation: *Division of Orthopedic Surgery, Department of Surgery, University of Montreal †CHU Ste-Justine ‡Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada §Children Hospital Boston, Boston, MA.
authors.forename: Marie-Lyne
authors.initials: ML
authors.lastname: Nault
authors.forename: Jonah
authors.initials: J
authors.lastname: Hébert-Davies
authors.forename: Yi-Meng
authors.initials: YM
authors.lastname: Yen
authors.forename: Benjamin
authors.initials: B
authors.lastname: Shore
authors.forename: Delma Y
authors.initials: DY
authors.lastname: Jarrett
authors.forename: Dennis E
authors.initials: DE
authors.lastname: Kramer
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000254:growth & development*; D002648:Child; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000293:injuries; D006801:Humans; D007593:Joint Instability; D008279:Magnetic Resonance Imaging; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012399:Rotation; D013639:Tarsal Bones; D013977:Tibia / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000293:injuries; D014057:Tomography, X-Ray Computed