Morphological Variations and Normal Parameters of the Cross-Sectional Anatomy of the Tibiofibular Syndesmotic

Background: The aim of this study was to determine morphological variations and normal parameters of the cross-sectional tibiofibular syndesmotic anatomy. Methods: Configurations of syndesmosis, anterior syndesmotic width (ASW), posterior syndesmotic width (PSW), and overlap distance, defined as the overlap of medial fibula with a drawn line from tip of anterior tubercle of incisura fibularis to the posterior tip, were measured on normal computed tomography (CT) scans of 110 cases. Results: Seventy seven male (70%) and 33 female (30%) (left: 50 and right: 60) were assessed. Mean age of the cases was 33 ± 13 (range: 15-80) years. Three different syndesmotic configurations were crescent (55.5%), rectangular (39.1 %), and semicircle (5.4 %). Overall, mean ASW, PSW, and overlap distance were 2.72, 3.98, and 1.02 mm, respectively. Upper limit of normal ASW in crescent, rectangular, and semicircle was 4.80, 4.85, and 3.89 mm, respectively. The maximum of PSW in crescent, rectangular, and semicircle was 6.25, 6.50, and 4.97 mm, respectively. There was not significant difference between syndesmotic configurations based on age (P = .69) and sex (P = .16). Conclusions: During interpreting axial CT scan to diagnose syndesmotic injuries, the normal range of parameters according to the different configurations of the tibiofibular syndesmosis should be carefully considered. Level of Evidence: Level 4

Modern approaches to the methods and treatment strategy in fractures of the ankle joint with tibiofibular syndesmosis rupture (literature review)

A review of the literature has shown that the problem of treatment for fractures of the ankle joint with rupture of the tibiofibular syndesmosis is still far from being solved, as evidenced by the frequency of unsatisfactory results during surgeries — 4.8–36.8 %. In the future, the issue and the need to develop a dynamic fixation device, which is able to duplicate the function lost due to damage to the tibiofibular syndesmosis, remain relevant.

Methods of Tibiofibular Syndesmosis Fixation

The tibiofibular syndesmosis is a ligamentous structure connecting the distal ends of the tibia and fibula. This article presents and compares the available methods of treatment of syndesmosis injuries. Current publications from the online database PubMed and relevant available books are analysed and compared with AO Surgery guidelines. Metal and bioabsorbable syndesmotic screws and the suture button technique, including all possible modifications of these approaches, are compared. The focus is on the technical aspects of the procedures, functional outcomes and complications of these procedures. According to the literature, the best long-term functional outcomes are obtained with the dynamic fixation method involving the suture button. This fixation technique is closest to a physiological connection, there is no need to subsequently remove the implant and return to work is faster. Given all this, the popularity of this fixation technique can be expected to increase dynamically.

Closed posterior dislocation of ankle joint without fracture: A case report and literature review

Pure Ankle dislocation is an ankle dislocation without any associated fractures of the ankle and an intact tibiofibular syndesmosis. Only a few isolated case reports and small series of cases are reported in literature. We report a posterior dislocation of ankle joint without any bony fractures with description of its mechanism, management, and literature review Keywords: Pure Ankle dislocation; ankle dislocation without fracture; posterior dislocation of ankle.