Chronic ankle joint instability: in unrecognized distal rupture of the syndosmosis and malunion of the distal fibula

It is often difficult in the acute phase to diagnose a lesion of the distal tibiofibular syndesmosis. If this lesion is overlooked, the patient will develop an incongruity of the upper ankle joint with a pathological external rotation of the talus. The risk of a possible premature arthritis is clear...

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Bibliographic Details
Published in:Der Orthopäde 2014-04, Vol.43 (4), p.379-385
Main Authors: Michelitsch, C, Acklin, Y P, Stoffel, K, Bereiter, H
Format: Article
Language:ger
Subjects:
Adolescent
Ankle Fractures - diagnostic imaging
Ankle Fractures - surgery
Arthroplasty - methods
Chronic Disease
Combined Modality Therapy - methods
False Negative Reactions
Female
Fibula - diagnostic imaging
Fibula - injuries
Fractures, Malunited - diagnostic imaging
Fractures, Malunited - surgery
Humans
Joint Instability - diagnostic imaging
Joint Instability - surgery
Multiple Trauma - surgery
Osteotomy - methods
Radiography
Reconstructive Surgical Procedures - methods
Rupture - diagnostic imaging
Rupture - surgery
Tendon Injuries - diagnostic imaging
Tendon Injuries - surgery
Tendons - diagnostic imaging
Tendons - transplantation
Treatment Outcome
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Summary:It is often difficult in the acute phase to diagnose a lesion of the distal tibiofibular syndesmosis. If this lesion is overlooked, the patient will develop an incongruity of the upper ankle joint with a pathological external rotation of the talus. The risk of a possible premature arthritis is clearly increased. In this case study a distal rupture of the syndesmosis in a young patient was overlooked in the initial diagnostic work-up. A search of the relevant literature and a case report. In the case described the shortened fibula and chronic instability of the tibiofibular syndesmosis were repaired with a lengthening and derotational osteotomy and reconstruction using the gracilis muscle tendon. Through this method an exact reconstruction of the normal anatomy could be achieved. Posttraumatic misalignment in the ankle joint is associated with a high risk of secondary degenerative lesions. In cases with suspicion of a syndesmosis lesion, confirmation of the diagnosis is imperative so as to perform an anatomic repositioning and reconstruction of stability.
ISSN:1433-0431
DOI:10.1007/s00132-014-2268-4