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Diagnosing and Treating Syndesmotic Ankle Injuries

Injuries of the ankle can involve bone, soft tissues, or both. A specific ankle injury called the syndesmotic injury is the topic of this review article. The syndesmosis is made up of four ligaments and a band of connective tissue. This band is called the interosseous membrane. It is located between the two bones of the lower leg.

Two orthopedic surgeons from the University of Southern California sum up the latest findings in the diagnosis and treatment of ankle syndesmotic injuries. X-rays are important, including the lateral view (from the side). This will help avoid missing certain types of fractures linked with syndesmotic injuries.

But X-rays don't always show a syndesmotic injury. The surgeon must also conduct two stress tests: the squeeze test and the external rotation test. Both tests are described in detail. Other imaging tests may also be needed. MRIs are very helpful in showing syndesmotic injuries.

The goal of treatment is to restore the normal alignment of the bones. This will give the ligaments time to heal. Surgery is needed when there is a bone fracture and torn syndesmosis. Nonoperative care may be all that's needed when the syndesmosis is sprained. The R.I.C.E. principle is used: rest, ice, compression, and elevation.

The authors discuss various ways to surgically repair a syndesmotic injury. Types of screws, number of screws, and placement are presented. X-rays and drawings are provided to show the correct placement of a syndesmotic screw. It is advised that patients keep the weight off the foot for at least six weeks. The screws can be taken out in most patients after 12 weeks.

The authors conclude that finding and treating syndesmotic injuries is important. Failure to identify such injuries leads to an unstable ankle and decreased function. The diagnosis of syndesmotic injuries is not always simple. But with a good history, careful clinical exam, and proper testing, most syndesmotic injuries can be found early.

Charalampos Zalavras, MD, PhD, and David Thordarson, MD. Ankle Syndesmotic Injury. In Journal of the American Academy of Orthopaedic Surgeons. June 2007. Vol. 15. No. 6. Pp. 330-339.

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