We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Ankle syndesmosis injury
From WikEM
Contents
Background
- 5-18% of all ankle sprains injure the distal tibiofibular syndesmosis [1]
- Highly unstable if the deltoid ligament is injured as well
- Mechanism is via external rotation and hyperdorsiflexion
- Associated with Maisonneuve fracture
Clinical Features
- Toe walking: to prevent painful dorsiflexion
- External rotation stress test: flex knee at 90 degrees then externally rotate the foot
- Squeeze/Hopkin's test: compress mid/proximal calf to separate the tibia and fibula distally
Differential Diagnosis
Other Ankle Injuries
- Ankle sprain
- Ankle dislocation
- Ankle syndesmosis injury
- Radiograph-negative ankle injury (peds)
Distal Leg Fractures
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Foot and toe fractures
Foot and Toe Fractures
Hindfoot
Midfoot
Forefoot
Evaluation
- Decreased tibio-fibular overlap (normally >6mm on AP films measured 1 cm proximal from the tibial plafond) [2]
- Increased tibio-fibular syndesmosis clear space (normally <6mm on AP films measured 1 cm proximal from the tibial plafond)
- Increased medial clear space (normally <5mm)
Management
- Non weight bearing
- Posterior ankle splint
Disposition
- Orthopedic follow up. May need screw fixation if joint is subluxed
See Also
External Links
https://emergencymedicinecases.com/episode-58-tendons-ligaments-missed-orthopedic-injuries/
References
- ↑ Lin, CF, Gross, ML, & Weinhold, P. Ankle syndesmosis injuries: Anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. 2006. J Orthop Sports Phys Ther, 36(6): 372-84
- ↑ Heest, TJ & Lafferty, PM. Injuries to the ankle syndesmosis. 2014. J Bone Joint Surg Am, 96(7): 603-13
