Case Report

Chronic Injury of Distal Tibiofibular Syndesmosis with Ankle Fracture Dislocation: A Case Report

Abstract

Background: Syndesmotic injury is one of the major causes of ankle pain and arthritis in athletes. Syndesmotic instability may remain undetectable when occurring with ankle fractures.
Case Report: A 59-year-old man presented to the orthopedic clinic with a history of surgery for fracture-dislocation of ankle two months before his visit. During revision surgery, we performed an open reduction, tension band wiring (TBW), and syndesmotic screw fixation. The results were satisfactory, with an almost full ankle range of motion (ROM) and good skin condition.
Conclusion: Early diagnosis and treatment of syndesmosis injury can prevent the complications such as chronic pain, osteoarthritis (OA), and stiffness. There is no consensus on the treatment of syndesmosis injury, but the main factors in determining the treatment plan are tibiofibular joint stability or instability and the amount of time that the injury has occurred. Magnetic resonance imaging (MRI) and computed tomography (CT) can also be used in addition to X-rays in cases of suspected syndesmosis injury.

1. Rammelt S, Zwipp H, Grass R. Injuries to the distal tibiofibular syndesmosis: An evidence-based approach to acute and chronic lesions. Foot Ankle Clin. 2008;13(4):611-viii. doi: 10.1016/j.fcl.2008.08.001. [PubMed: 19013399].

2. Gieroba TJ, Munn Z, Cundy PJ, Eardley-Harris N. Fixation methods for acute injuries of the ankle syndesmosis: A systematic review protocol. JBI Database System Rev Implement Rep. 2016;14(8):43-51. doi: 10.11124/JBISRIR-2016-003060. [PubMed: 27635744].

3. van den Bekerom MP, Lamme B, Hogervorst M, Bolhuis HW. Which ankle fractures require syndesmotic stabilization? J Foot Ankle Surg. 2007;46(6):456-63. doi: 10.1053/j.jfas.2007.08.009. [PubMed: 17980843].

4. Frank AL, Charette RS, Groen K. Ankle dislocation. StatPearls. 2020; [PubMed: 32119497].

5. Coull R, Williams RL. Fractures of the ankle. Hosp Med. 2002;63(9):556-7. doi: 10.12968/hosp.2002.63.9.1954. [PubMed: 12357861].

6. Lawson KA, Ayala AE, Morin ML. Ankle fracture-dislocations: A

review. Foot & Ankle Orthopaedics. 2018;3(3): doi: 10.1177/2473011418765122.

7. Mandi DM. Ankle fractures. Clin Podiatr Med Surg. 2012;29(2):155-86, vii. doi: 10.1016/j.cpm.2012.01.002. [PubMed: 22424483].

8. de-Las-Heras Romero J, Alvarez AML, Sanchez FM, Garcia AP, Porcel PAG, Sarabia RV, et al. Management of syndesmotic injuries of the ankle. EFORT Open Rev. 2017;2(9):403-9. doi: 10.1302/2058-5241.2.160084. [PubMed: 29071125]. [PubMed Central: PMC5644422].

9. Beals TC, Manoli A. Late syndesmosis reconstruction: A case

report. Foot Ankle Int. 1998;19(7):485-8. doi:

10.1177/107110079801900712. [PubMed: 9694129].
10. Harper MC. Delayed reduction and stabilization of the tibiofibular syndesmosis. Foot Ankle Int. 2001;22(1):15-8. doi: 10.1177/107110070102200103. [PubMed: 11206818].

11. Kennedy MA, Sama AE, Sigman M. Tibiofibular syndesmosis and ossification. Case report: Sequelae of ankle sprain in an adolescent football player. J Emerg Med. 2000;18(2):233-40. doi: 10.1016/s0736-4679(99)00201-2. [PubMed: 10699529].

12. Schuberth JM, Jennings MM, Lau AC. Arthroscopy-assisted repair of latent syndesmotic instability of the ankle. Arthroscopy. 2008;24(8):868-74. doi: 10.1016/j.arthro.2008.02.013. [PubMed: 18657734].

13. Beumer A, Heijboer RP, Fontijne WP, Swierstra BA. Late reconstruction of the anterior distal tibiofibular syndesmosis: Good outcome in 9 patients. Acta Orthop Scand. 2000;71(5):519-

21. doi: 10.1080/000164700317381243. [PubMed: 11186412].

14. Miyamoto W, Takao M. Management of chronic disruption of the distal tibiofibular syndesmosis. World J Orthop. 2011;2(1):1-6. doi: 10.5312/wjo.v2.i1.1. [PubMed: 22474625]. [PubMed Central: PMC3302031].

15. Katznelson A, Lin E, Militiano J. Ruptures of the ligaments about the tibio-fibular syndesmosis. Injury. 1983;15(3):170-2. doi: 10.1016/0020-1383(83)90007-4. [PubMed: 6642626].

16. Pena FA, Coetzee JC. Ankle syndesmosis injuries. Foot Ankle Clin. 2006;11(1):35-50, viii. doi: 10.1016/j.fcl.2005.12.007. [PubMed: 16564452].

17. Porter DA, Jaggers RR, Barnes AF, Rund AM. Optimal management of ankle syndesmosis injuries. Open Access J Sports Med. 2014;5:173-82. doi: 10.2147/OAJSM.S41564. [PubMed: 25177153]. [PubMed Central: PMC4128849].

18. Naqvi GA, Shafqat A, Awan N. Tightrope fixation of ankle syndesmosis injuries: Clinical outcome, complications and technique modification. Injury. 2012;43(6):838-42. doi: 10.1016/j.injury.2011.10.002. [PubMed: 22036451].

19. Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Suture-button syndesmosis fixation: Accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. 2005;(431):207-12. [PubMed: 15685077].
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IssueVol 6, No 1 (2020) QRcode
SectionCase Report
DOI https://doi.org/10.18502/jost.v6i1.4537
Keywords
Ankle Injury; Syndesmotic Injury; Tibiofibular Ankle Syndesmosis; Distal Tibiofibular Joint

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How to Cite
1.
Mahmoudi E, Nabian MH. Chronic Injury of Distal Tibiofibular Syndesmosis with Ankle Fracture Dislocation: A Case Report. J Orthop Spine Trauma. 2020;6(1):16-9.