Saturday, August 9, 2008

DISTAL TIBIOFIBULAR SYNDESMOSIS RUPTURE

The incidence of isolated distal tibiofibular syndesmotic ruptures in acute ankle sprains lies between 1% and 11%.
It is misdiagnosed as anterolateral rotational instability of the ankle and often become apparent through protracted courses.
The pathomechanics and extent of syndesmotic injuries have been systematically described by Lauge-Hansen and Weber.
PATHOMECHANICS: Tibiofibular diastasis secondary to chronic syndesmotic instability leads to external rotation of the talus. In combination with a valgus position of the talus, this instability leads to a decrease in the contact area which results in posttraumatic arthritic changes.
SURGICAL AIM:
These complex injuries are treated surgically to ensure sufficient and stable healing of the syndesmosis besides correct alignment of the distal fibula.
To restore the stability of the ankle mortise and alignment of the fibula in the tibiofibular incisura to ensure limitation of talar rotation.

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