BACKGROUND: It is often difficult in the acute phase to diagnose a lesion of the distal tibiofibular syndesmosis. If this lesion is overlooked, the patient will develop an incongruity of the upper ankle joint with a pathological external rotation of the talus. The risk of a possible premature arthritis is clearly increased. OBJECTIVES: In this case study a distal rupture of the syndesmosis in a young patient was overlooked in the initial diagnostic work-up. METHODS: A search of the relevant literature and a case report. RESULTS: In the case described the shortened fibula and chronic instability of the tibiofibular syndesmosis were repaired with a lengthening and derotational osteotomy and reconstruction using the gracilis muscle tendon. Through this method an exact reconstruction of the normal anatomy could be achieved. CONCLUSION: Posttraumatic misalignment in the ankle joint is associated with a high risk of secondary degenerative lesions. In cases with suspicion of a syndesmosis lesion, confirmation of the diagnosis is imperative so as to perform an anatomic repositioning and reconstruction of stability.
BACKGROUND: It is often difficult in the acute phase to diagnose a lesion of the distal tibiofibular syndesmosis. If this lesion is overlooked, the patient will develop an incongruity of the upper ankle joint with a pathological external rotation of the talus. The risk of a possible premature arthritis is clearly increased. OBJECTIVES: In this case study a distal rupture of the syndesmosis in a young patient was overlooked in the initial diagnostic work-up. METHODS: A search of the relevant literature and a case report. RESULTS: In the case described the shortened fibula and chronic instability of the tibiofibular syndesmosis were repaired with a lengthening and derotational osteotomy and reconstruction using the gracilis muscle tendon. Through this method an exact reconstruction of the normal anatomy could be achieved. CONCLUSION: Posttraumatic misalignment in the ankle joint is associated with a high risk of secondary degenerative lesions. In cases with suspicion of a syndesmosis lesion, confirmation of the diagnosis is imperative so as to perform an anatomic repositioning and reconstruction of stability.
Authors: Michael J Gardner; Demetris Demetrakopoulos; Stephen M Briggs; David L Helfet; Dean G Lorich Journal: Foot Ankle Int Date: 2006-10 Impact factor: 2.827