Ankle Arthritis Combined With Chronic Instability of the Syndesmosis After Ankle Fracture With Syndesmotic Injury: A Case Report.

Syndesmotic injuries associated with ankle fractures are commonly treated with reduction and fixation using a transfixing screw. On rare occasions, however, progression to chronic instability of the syndesmosis is observed. Several surgical techniques have been applied in such cases but usually without a report on the results. We report a case of chronic syndesmotic instability and ankle joint osteoarthritis after ankle fracture-dislocation in a 21-year-old male patient who underwent distal tibiofibular arthrodesis. During the relatively long 4-year, 1-month follow-up period, the pain and activity improved from the patient's preoperative condition. Radiographs demonstrated cessation of arthritic changes in the ankle that had initially displayed joint space narrowing. Our findings suggest distal tibiofibular arthrodesis as an option to consider for the treatment of young and active patients with arthritic changes in the ankle joint with concomitant chronic instability of the syndesmosis.

[1]  E. V. van Lieshout,et al.  Aftercare following syndesmotic screw placement: a systematic review. , 2013, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[2]  T. Schepers Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair , 2012, International Orthopaedics.

[3]  B. Toolan,et al.  Salvage of chronic instability of the syndesmosis with distal tibiofibular arthrodesis: functional and radiographic results. , 2011, The Journal of bone and joint surgery. American volume.

[4]  M. Myerson,et al.  Acute and chronic syndesmosis injuries: pathomechanisms, diagnosis and management. , 2006, Foot and ankle clinics.

[5]  F. Peña,et al.  Ankle syndesmosis injuries. , 2006, Foot and ankle clinics.

[6]  J. Pajarinen,et al.  Fixation of Syndesmotic Ruptures in 38 Patients With a Malleolar Fracture: A Randomized Study Comparing a Metallic and a Bioabsorbable Screw , 2005, Journal of orthopaedic trauma.

[7]  J. Albright,et al.  Distal tibiofibular syndesmosis fixation: a cadaveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation. , 2005, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[8]  M. Bhandari,et al.  Predictors of Functional Outcome Following Transsyndesmotic Screw Fixation of Ankle Fractures , 2005, Journal of orthopaedic trauma.

[9]  E. Masterson,et al.  Suture-Button Syndesmosis Fixation: Accelerated Rehabilitation and Improved Outcomes , 2005, Clinical orthopaedics and related research.

[10]  R. Niesing,et al.  Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation. , 2005, Injury.

[11]  K. Strømsøe,et al.  Tricortical Versus Quadricortical Syndesmosis Fixation in Ankle Fractures: A Prospective, Randomized Study Comparing Two Methods of Syndesmosis Fixation , 2004, Journal of orthopaedic trauma.

[12]  H. Zwipp,et al.  Peroneus Longus Ligamentoplasty for Chronic Instability of the Distal Tibiofibular Syndesmosis , 2003, Foot & ankle international.

[13]  G. Pomeroy,et al.  Syndesmosis injuries: acute, chronic, new techniques for failed management. , 2002, Foot and ankle clinics.

[14]  W. D. Hovis,et al.  Treatment of Syndesmotic Disruptions of the Ankle with Bioabsorbable Screw Fixation , 2002, The Journal of bone and joint surgery. American volume.

[15]  D. S. Gesink,et al.  Biomechanical Comparison of Syndesmosis Fixation with 3.5- and 4.5-millimeter Stainless Steel Screws , 2000, Foot & ankle international.

[16]  A. Beumer,et al.  Late reconstruction of the anterior distal tibiofibular syndesmosis: Good outcome in 9 patients , 2000, Acta orthopaedica Scandinavica.

[17]  A. Manoli,et al.  Late Syndesmosis Reconstruction: A Case Report , 1998, Foot & ankle international.

[18]  N. Ebraheim,et al.  Ankle Fractures Involving the Fibula Proximal to the Distal Tibiofibular Syndesmosis , 1997, Foot & ankle international.

[19]  P. Bacilla,et al.  Syndesmotic Screw Placement: A Biomechanical Analysis , 1997, Foot & ankle international.

[20]  T. Wuest Injuries to the Distal Lower Extremity Syndesmosis , 1997, The Journal of the American Academy of Orthopaedic Surgeons.

[21]  H. Chissell,et al.  The influence of a diastasis screw on the outcome of Weber type-C ankle fractures. , 1995, The Journal of bone and joint surgery. British volume.

[22]  K. Yamaguchi,et al.  Operative Treatment of Syndesmotic Disruptions Without Use of a Syndesmotic Screw: A Prospective Clinical Study , 1994, Foot & ankle international.

[23]  M. Harper The deltoid ligament. An evaluation of need for surgical repair. , 1988, Clinical orthopaedics and related research.

[24]  M. Ehrlich,et al.  Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. , 1984, The Journal of bone and joint surgery. American volume.