Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Isolated Syndesmotic Injury

원위 경비 인대 결합의 단독 손상

  • Kim, Yong Tae (Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Hyong Nyun (Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Yong Wook (Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine)
  • 김용태 (한림대학교 의과대학 강남성심병원 정형외과학교실) ;
  • 김형년 (한림대학교 의과대학 강남성심병원 정형외과학교실) ;
  • 박용욱 (한림대학교 의과대학 강남성심병원 정형외과학교실)
  • Received : 2016.07.13
  • Accepted : 2016.08.11
  • Published : 2016.09.15
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Abstract

Syndesmotic injury can either be isolated or associated with bony or ligamentous ankle injury. When it is not associated with an ankle fracture, it may not be easy to diagnose, especially when there is no franck diastasis on a plain radiograph. Without proper treatment, syndesmotic injury can lead to chronic pain due to impingement of scar tissues and instability. It may further lead to ankle arthritis. Early diagnosis with appropriate management is a prerequisite to avoid these problems. Herein, we review and discuss the mechanism of injury, classification, diagnosis, and treatment of isolated syndesmotic injury.

Keywords

References

  1. van Dijk CN, Longo UG, Loppini M, Florio P, Maltese L, Ciuffreda M, et al. Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc. 2016;24:1200-16. https://doi.org/10.1007/s00167-015-3942-8
  2. van Dijk CN, Longo UG, Loppini M, Florio P, Maltese L, Ciuffreda M, et al. Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc. 2016;24:1217-27. https://doi.org/10.1007/s00167-016-4017-1
  3. Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. 1990;10:325-30. https://doi.org/10.1177/107110079001000607
  4. Gwak HC, Kwon YW. Ankle syndesmotic injury. J Korean Foot Ankle Soc. 2011;15:187-94.
  5. Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007;15:330-9. https://doi.org/10.5435/00124635-200706000-00002
  6. Miller TL, Skalak T. Evaluation and treatment recommendations for acute injuries to the ankle syndesmosis without associated fracture. Sports Med. 2014;44:179-88. https://doi.org/10.1007/s40279-013-0106-1
  7. Edwards GS Jr, DeLee JC. Ankle diastasis without fracture. Foot Ankle. 1984;4:305-12. https://doi.org/10.1177/107110078400400606
  8. Frick H. Diagnosis, therapy and results of acute instability of the syndesmosis of the upper ankle joint (isolated anterior rupture of the syndesmosis). Orthopade. 1986;15:423-6.
  9. Lee KB. Ankle syndesmotic injury. J Korean Fract Soc. 2007;20:282-90. https://doi.org/10.12671/jkfs.2007.20.3.282
  10. Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19:653-60. https://doi.org/10.1177/107110079801901002
  11. Ogilvie-Harris DJ, Gilbart MK, Chorney K. Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy. 1997;13:564-74. https://doi.org/10.1016/S0749-8063(97)90181-X
  12. Van Heest TJ, Lafferty PM. Injuries to the ankle syndesmosis. J Bone Joint Surg Am. 2014;96:603-13. https://doi.org/10.2106/JBJS.M.00094
  13. Ostrum RF, De Meo P, Subramanian R. A critical analysis of the anterior-posterior radiographic anatomy of the ankle syndesmosis. Foot Ankle Int. 1995;16:128-31. https://doi.org/10.1177/107110079501600304
  14. Rammelt S, Zwipp H, Grass R. Injuries to the distal tibiofibular syndesmosis: an evidence-based approach to acute and chronic lesions. Foot Ankle Clin. 2008;13:611-33. https://doi.org/10.1016/j.fcl.2008.08.001
  15. Degroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32:250-6. https://doi.org/10.3113/FAI.2011.0250
  16. Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, et al. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot Ankle Int. 2012;33:371-8. https://doi.org/10.3113/FAI.2012.0371
  17. van den Bekerom MP, de Leeuw PA, van Dijk CN. Delayed operative treatment of syndesmotic instability. Current concepts review. Injury. 2009;40:1137-42. https://doi.org/10.1016/j.injury.2009.03.011
  18. Espinosa N, Smerek JP, Myerson MS. Acute and chronic syndesmosis injuries: pathomechanisms, diagnosis and management. Foot Ankle Clin. 2006;11:639-57. https://doi.org/10.1016/j.fcl.2006.07.006
  19. Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18:693-8. https://doi.org/10.1177/107110079701801103
  20. Harper MC, Keller TS. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle. 1989;10:156-60. https://doi.org/10.1177/107110078901000308
  21. Lee HS, Park SS, Kim JW, Shin MJ, Kim SM, Lee SH, et al. Diagnostic value of ultrasonography for acute tear of tibiofibular syndesmosis in ankle. J Korean Foot Ankle Soc. 2004;8:1-6.
  22. Reckling FW, McNamara GR, DeSmet AA. Problems in the diagnosis and treatment of ankle injuries. J Trauma. 1981;21:943-50. https://doi.org/10.1097/00005373-198111000-00006
  23. Han SH, Lee JW, Kim S, Suh JS, Choi YR. Chronic tibiofibular syndesmosis injury: the diagnostic efficiency of magnetic resonance imaging and comparative analysis of operative treatment. Foot Ankle Int. 2007;28:336-42. https://doi.org/10.3113/FAI.2007.0336
  24. Vogl TJ, Hochmuth K, Diebold T, Lubrich J, Hofmann R, Stockle U, et al. Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis. Invest Radiol. 1997;32:401-9. https://doi.org/10.1097/00004424-199707000-00006
  25. Magan A, Golano P, Maffulli N, Khanduja V. Evaluation and management of injuries of the tibiofibular syndesmosis. Br Med Bull. 2014;111:101-15. https://doi.org/10.1093/bmb/ldu020
  26. Ogilvie-Harris DJ, Reed SC. Disruption of the ankle syndesmosis: diagnosis and treatment by arthroscopic surgery. Arthroscopy. 1994;10:561-8. https://doi.org/10.1016/S0749-8063(05)80015-5
  27. Heim D, Schmidlin V, Ziviello O. Do type B malleolar fractures need a positioning screw? Injury. 2002;33:729-34. https://doi.org/10.1016/S0020-1383(01)00199-1
  28. Kaukonen JP, Lamberg T, Korkala O, Pajarinen J. Fixation of syndesmotic ruptures in 38 patients with a malleolar fracture: a randomized study comparing a metallic and a bioabsorbable screw. J Orthop Trauma. 2005;19:392-5. https://doi.org/10.1097/01.bot.0000155313.50627.f6
  29. Naqvi GA, Cunningham P, Lynch B, Galvin R, Awan N. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012;40:2828-35. https://doi.org/10.1177/0363546512461480
  30. Needleman RL, Skrade DA, Stiehl JB. Effect of the syndesmotic screw on ankle motion. Foot Ankle. 1989;10:17-24. https://doi.org/10.1177/107110078901000104
  31. Thompson MC, Gesink D, Hamson K. Biomechanical evaluation of syndesmosis fixation with 3.5- and 4.5-millimeter stainless steel screws. J Orthop Trauma. 2000;14:144.
  32. Kukreti S, Faraj A, Miles JN. Does position of syndesmotic screw affect functional and radiological outcome in ankle fractures? Injury. 2005;36:1121-4. https://doi.org/10.1016/j.injury.2005.01.014
  33. Sinisaari IP, Luthje PM, Mikkonen RH. Ruptured tibio-fibular syndesmosis: comparison study of metallic to bioabsorbable fixation. Foot Ankle Int. 2002;23:744-8. https://doi.org/10.1177/107110070202300811
  34. Thordarson DB, Hedman TP, Gross D, Magre G. Biomechanical evaluation of polylactide absorbable screws used for syndesmosis injury repair. Foot Ankle Int. 1997;18:622-7. https://doi.org/10.1177/107110079701801004
  35. van den Bekerom MP, Hogervorst M, Bolhuis HW, van Dijk CN. Operative aspects of the syndesmotic screw: review of current concepts. Injury. 2008;39:491-8. https://doi.org/10.1016/j.injury.2007.11.425
  36. Parlamas G, Hannon CP, Murawski CD, Smyth NA, Ma Y, Kerkhoffs GM, et al. Treatment of chronic syndesmotic injury: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21:1931-9. https://doi.org/10.1007/s00167-013-2515-y
  37. Yasui Y, Takao M, Miyamoto W, Innami K, Matsushita T. Anatomical reconstruction of the anterior inferior tibiofibular ligament for chronic disruption of the distal tibiofibular syndesmosis. Knee Surg Sports Traumatol Arthrosc. 2011;19:691-5. https://doi.org/10.1007/s00167-010-1311-1
  38. Zamzami MM, Zamzam MM. Chronic isolated distal tibiofibular syndesmotic disruption: diagnosis and management. Foot Ankle Surg. 2009;15:14-9. https://doi.org/10.1016/j.fas.2008.04.002
  39. Olson KM, Dairyko GH Jr, Toolan BC. Salvage of chronic instability of the syndesmosis with distal tibiofibular arthrodesis: functional and radiographic results. J Bone Joint Surg Am. 2011;93:66-72.