The Syndesmosis, Part I: Anatomy, Injury Mechanism, Classification, and Diagnosis

Lorena Bejarano-Pineda; Daniel Guss; Gregory Waryasz; Christopher W DiGiovanni; John Y Kwon

doi:10.1016/j.ocl.2021.05.010

The Syndesmosis, Part I: Anatomy, Injury Mechanism, Classification, and Diagnosis

Orthop Clin North Am. 2021 Oct;52(4):403-415. doi: 10.1016/j.ocl.2021.05.010. Epub 2021 Jul 29.

Authors

Lorena Bejarano-Pineda¹, Daniel Guss¹, Gregory Waryasz¹, Christopher W DiGiovanni¹, John Y Kwon²

Affiliations

¹ 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, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA.
² 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, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA. Electronic address: johnkwonmd@gmail.com.

PMID: 34538351
DOI: 10.1016/j.ocl.2021.05.010

Abstract

Ankle fractures are common injuries to the lower extremity with approximately 20% sustaining a concomitant injury to the syndesmosis. Although the deltoid ligament is not formally included in the syndesmotic complex, it plays an important role in the mortise stability. Therefore, its integrity should be always evaluated when syndesmotic injury is suspected. Given the anatomic variability of the syndesmosis between individuals, bilateral ankle imaging is recommended, especially in cases of subtle instability. Diagnostic tests that allow dynamic assessment of the distal tibiofibular joint in the 3 planes are the most reliable in determining the presence of syndesmotic injury.

Keywords: Advanced imaging; Classification; Diagnosis; Stress radiographs; Syndesmosis; Syndesmotic injury.

Publication types

Review

MeSH terms

Ankle Fractures* / classification
Ankle Fractures* / diagnosis
Ankle Fractures* / etiology
Ankle Fractures* / therapy
Ankle Injuries* / classification
Ankle Injuries* / diagnosis
Ankle Injuries* / etiology
Ankle Injuries* / therapy
Ankle Joint / anatomy & histology*
Ankle Joint / diagnostic imaging
Humans