Imaging of the Distal Tibiofibular Syndesmosis: Anatomy in Relation to Radiological Diagnosis

Injury to the distal tibiofibular syndesmosis can occur after an ankle sprain or after an acute ankle fracture. In an estimated 1-11% of all ankle sprains, injury of the distal tibiofibular syndesmosis occurs which is known as a high ankle sprain. However, depending on the type and level of sporting activities the incidence of syndesmotic injury can be as high as 75%. Whether acute ankle fractures are accompanied with injury of the syndesmosis depends on the type of ankle fracture. Based on radiological findings, several fracture classification systems have been developed. These classifications can aid in predicting the presence of injury to the syndesmosis in relation to the level of the fibula fracture or to the mechanism of trauma. Clinically frequently used fracture classification systems are the Danis-Weber and AO-Müller classification that pertain to the level of the distal fibula fracture, and the Lauge- Hansen classification which is based on the trauma mechanism, i.e. on the position of the foot at the moment of injury and the direction in which the talus moves within the ankle mortise. Detailed information about the three fracture classifications can be found in tables 1-3. Despite the frequency and importance of injury of the syndesmosis, the management of this kind of injury has remained controversial. In order to use a fracture classification which uses the distal tibiofibular syndesmosis as a point of reference, good knowledge about the syndesmosis is fundamental. This concerns not only information about the exact boundaries of the syndesmosis, but also the exact location and direction of the tibiofibular ligaments.

• View at Worldcat

Free Full Text ( Final Version , 110mb )