Distale tibiofibulaire syndesmoseletsels

The distal tibiofibular joint is a syndesmosis between the convex surface of the distal fibula and the concave joint surface of the distal tibia. Four ligaments connect the distal fibula shaft with the distal tibial shaft at the distal tibiofibular joint. Syndesmotic injuries vary from a simple ankle sprain to severe ankle fractures associated with syndesmotic ligament rupture. The distal tibiofibular syndesmotic ligaments are important for stability of the ankle mortise and therefore for weight transmission and walking. The ankle mortise widens and the fibula externally rotates when the foot is moved from a plantarflexed position to a dorsiflexed position and with weight bearing. Isolated syndesmotic injuries are mostly caused by a combination of exorotation, axial compression and forced dorsalflexion in the tibiotalar joint. Some specific physical tests are available to evaluate the syndesmotic ligaments. Radiological criteria can be used to evaluate the syndesmotic ligament integrity on an anteroposterior conventional ankle view. The tibiofibular clear space is the distance between the lateral site of the malleolus tertius and the medial site of the fibula. The tibiofibular overlap is the distance between the medial site of the fibula and the lateral site of the distal tibia. When performing an open reduction and internal fixation of the fibula fracture, the stability of the syndesmotic ligaments can be evaluated perioperatively. In this review article the operative and non-operative treatment options of isolated syndesmotic ruptures or associated with lateral ankle ligament injury or an ankle fracture are summarised.