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Two Cases of Syndesmosis Injuries Reviewed

In this study orthopedic surgeons from the University of Kentucky Sports Medicine clinic report on two cases of syndesmosis ankle injury. In this type of ankle sprain, the ligaments and connective tissue holding the lower leg bones together are torn. The two bones involved are the tibia and fibula.

The authors review the ankle anatomy and testing used to diagnose syndesmosis injuries. Pain and swelling above the ankle joint line in the front of the ankle in the first 24 hours after injury is a red flag for this condition.

Syndesmosis injuries are uncommon and easy to overlook or miss at first. Plain X-rays are used to help identify the problem in the acute phase. Stress X-rays are needed to see them clearly later on if the injury is missed at first. The exact measurements for normal spacing between the bones is reviewed for plain X-rays, CT scans, and stress radiographs.

Early treatment is needed to avoid future ankle problems, especially arthritis. Treatment is determined based on the X-rays. If the space between the bones looks normal then rest, ice, and elevation are used. The patient stays off the foot for a short while. Bracing and rehab may be needed.

When a large gap between the bones is seen on X-ray then surgery is likely. One or two screws are used to hold the bones in place during healing. The patient wears a non-weight-bearing boot for six weeks. They are allowed to move the ankle. After six weeks the patient can put weight on the foot while wearing the boot. The boot can come off at the end of three months.

Athletes with syndesmosis ankle injuries should be told that healing takes longer with this type of sprain compared to other ankle sprains. Return to play is possible but delayed.

Brandon Fites, MD, et al. Latent Syndesmosis Injuries in Athletes. In Orthopedics. February 2006. Vol. 29. No. 2. Pp. 124-128.

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