2 Indications and current treatments
2.1 Syndesmotic injuries at the ankle joint are injuries to the ligaments that connect the tibia and fibula. They are the most severe ligament injuries to the ankle, and occur either in isolation or at the same time as an ankle fracture. The most common mechanisms causing syndesmotic injuries are external rotation and/or hyperdorsiflexion. These injuries can occur during activities such as sports or dancing, and from falls or slipping on ice. Patients with isolated syndesmotic injuries such as acute ankle sprains have acute ankle instability, pain and functional problems.
2.2 Isolated syndesmotic injuries can sometimes be treated conservatively with immobilisation, limited weight bearing, ankle exercises, compression and elevation. Distal tibiofibular syndesmosis, syndesmotic injuries with persistent symptoms and all syndesmotic injuries occurring with ankle fractures are normally treated by surgical rigid fixation with syndesmotic screws (either single or double screws). The screws are often removed at a subsequent operation. Other fixation methods include bolt fixation and syndesmotic hooks, both of which may also be removed at a subsequent operation, and staples or direct repair.
2.3 Anatomical reduction of the syndesmosis is desirable because any abnormal shift of the talus in the ankle mortise causes development of early and progressive osteoarthritis.