The Syndesmosis, Part II: Surgical Treatment Strategies

Philip B Kaiser; Lorena Bejarano-Pineda; John Y Kwon; Christopher W DiGiovanni; Daniel Guss

doi:10.1016/j.ocl.2021.05.011

The Syndesmosis, Part II: Surgical Treatment Strategies

Orthop Clin North Am. 2021 Oct;52(4):417-432. doi: 10.1016/j.ocl.2021.05.011. Epub 2021 Jul 30.

Authors

Philip B Kaiser¹, Lorena Bejarano-Pineda², John Y Kwon², Christopher W DiGiovanni², Daniel Guss²

Affiliations

¹ Department of Orthopaedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, MA, USA; Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, Boston, MA, USA. Electronic address: pkaiser@mgh.harvard.edu.
² Department of Orthopaedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, MA, USA; Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, Boston, MA, USA.

PMID: 34538352
DOI: 10.1016/j.ocl.2021.05.011

Abstract

Syndesmotic injuries in the setting of ankle fracture are critically important to diagnosis and treat to restore an anatomic tibiotalar relationship. Physical examination and clinical suspicion remain critically important for diagnosis. Ultrasound examination and weight-bearing computed tomography scans are evolving to help diagnosis more subtle injuries. Although flexible syndesmotic fixation may decrease malreduction rates, the benefits over rigid fixation is the subject of ongoing study. Anatomic reduction remains critical regardless of fixation choice. Routine removal of rigid syndesmotic hardware does not seem to offer substantial clinical improvement in pain or range of motion; however, broken hardware may cause irritation.

Keywords: Flexible fixation; Rigid fixation; Screw; Surgical repair; Suture button; Syndesmosis; Syndesmotic instability.

Publication types

Review

MeSH terms

Ankle Fractures* / diagnosis
Ankle Fractures* / surgery
Ankle Injuries* / diagnosis
Ankle Injuries* / surgery
Ankle Joint / anatomy & histology*
Humans
Joint Instability / etiology
Joint Instability / surgery*
Ligaments, Articular / injuries*
Ligaments, Articular / surgery