Evolution of Technology

Syndesmosis Fixation

Syndesmosis fixation can be performed for those injuries indicated to undergo operative intervention. There are multiple methods of syndesmotic fixation to include both screw fixation as well as fixation with a suture button or tension wire construct. At this time there is no definitive evidence that either method is superior to the other. When screw fixation is utilized, a 3.5-4.5mm screw is placed across the tibio-fibular joint, essentially reinforcing their syndesmosis.

Typically, 2 screws are utilized, and they placed through both bones of the lower leg. An alternative is suture button or tension wire technology which accomplishes the same goal of re-enforcing the syndesmosis. In this technique, instead of utilizing screws, the surgeon uses a high-tension wire which spans the joint and is fixed to the bone on either side with a small button or some other method of fixation.

Evolution of Procedure

Open Reduction Internal Fixation of the Syndesmosis

For syndesmosis injuries that ae severe or are identified in association with an ankle fracture, a procedure must be performed to stabilize the syndesmosis and prevent further displacement and instability about the ankle. In this situation, open reduction and internal fixation if the syndesmosis is the preferred operative treatment. This procedure consists of making an incision at the outer aspect of the ankle overlying the fibula. If there is a fracture in this are then it is reduced and fixed in place with a plate and screws. Once the fracture is stabilized, or if there was no fracture, the fibula is then manipulated utilizing clamps or other reduction maneuvers until it is adequately reduced to the native anatomic location. This position is verified using intra-operative x-rays or fluoroscopy and then the bone is fixed in place.

Evolution of Diagnosis

Syndesmosis Injury

A syndesmosis injury is also known as a “high ankle sprain” and is seen commonly in high impact sports. The injury occurs in 0.5% of all ankle sprains and 13% of all ankle fractures. The syndesmosis is a complex grouping of ligaments present just above the ankle joint which functions to stabilize the ankle and attach the tibia or skin bone to the fibula, which is the smaller bone on the outside of the leg. Injury to the syndesmosis occurs commonly due to rotational injuries about the ankle and when it is injured, the ankle may become unstable. In these instances, if not identified and treated, progressive ankle instability can occur which can lead to poor outcomes with chronic loss of function and pain at the ankle. Minor injuries to the syndesmosis can be treated without surgery, but more major injuries and those that are associated with an ankle fracture must be treated operatively.