title: Management of syndesmotic injuries: What is the evidence?
abstract: Ankle fractures are accompanied by a syndesmotic injury in about 10% of operatively treated ankle fractures. Usually, the total rupture of the syndesmotic ligaments with an external rotation force is associated with a Weber type B or C fracture or a Maisonneuve fracture. The clinical assessment should consist of a comprehensive history including mechanism of injury followed by a specific physical examination. Radiographs, and if in doubt magnetic resonance imaging, are needed to ascertain the syndesmotic injury. In the case of operative treatment the method of fixation, the height and number of screws and the need for hardware removal are still under discussion. Furthermore, intraoperative assessment of the accuracy of reduction of the fibula in the incisura using fluoroscopy is difficult. A possible solution might be the assessment with intraoperative three-dimensional imaging. The aim of this article is to provide a current concepts review of the clinical presentation, diagnosis and treatment of syndesmotic injuries.
authors.affiliation: Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke, Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Schnetzke
authors.affiliation: Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke, Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: Sven Y
authors.initials: SY
authors.lastname: Vetter
authors.affiliation: Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke, Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Beisemann
authors.affiliation: Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke, Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: Benedict
authors.initials: B
authors.lastname: Swartman
authors.affiliation: Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke, Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grützner
authors.affiliation: Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke, Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Franke
keywords: Ankle; Ankle sprain; Syndesmotic injury; Syndesmotic screw; Three-dimensional; TightRope