CT Scan Assessment of the Syndesmosis

Abstract

Several studies have shown that the reduction of the syndesmosis is essential to restore normal ankle mechanics and prevent secondary degenerative changes. The evaluation criteria developed in this study can give the surgeon a guideline for evaluating syndesmosis anatomy with reliable parameters. Concerning the normal range of motion, our radiologic measurements of 100 normal ankles showed that a significant amount of variability exists in the uninjured distal tibiofibular relationship.

Acute and Chronic Injuries to the Syndesmosis

“…Just as with plain radiography, CT imaging has demonstrated variability in the anatomy of the syndesmosis between individuals. 64 Thus, bilateral imaging can be extremely useful. 65,66 Even after plain radiographs have demonstrated diastasis of the syndesmosis, CT scan can be a useful adjunct on the bony anatomy to guide surgical planning.…”

Management of Syndesmotic Disruption in Ankle Fractures

“…This was an improvement compared with a malreduction rate of 52% in a control group of twenty-five ankles that underwent postoperative CT evaluation after intraoperative fluoroscopy alone had been utilized for reduction 33 . Improved syndesmotic reduction with direct visualization of the joint has led some authors to advocate the routine use of open reduction 3,34 .…”

Radiographic evaluation of the ankle syndesmosis

“…Measurements were documented 1 cm above the centre of the tibial plafond. 8,12 Ratios were determined in order to assess the positional relationship of the tibia relative to the fibula. …”

“…It has been suggested that MRI, CT or arthroscopy should be used to ensure adequate diagnosis and treatment; [7][8][9][10]12 however, if it is possible to diagnose syndesmotic disruption with plain film radiography, significant cost and morbidity could be spared. Stress examination is another method that has been used to diagnose syndesmotic disruption; 9,[15][16][17] however, use of the mortise and AP views have continued to be the foundation for diagnosis.…”

“…[1][2][3] Recent literature has suggested, however, that evaluation of the syndesmosis on static AP and mortise views is not adequate to determine if there is a syndesmotic injury pre-sent. [4][5][6][7][8][9][10][11] It has been suggested that current diagnostic criteria used specifically for syndesmotic injuries are of minimal value and that further criteria should be developed. 5,6,9 Ankle arthroscopy, computed tomography (CT) or magnetic resonance imaging (MRI) have been suggested as alternatives to standard radiography to ensure proper diagnosis of syndesmotic injuries; [7][8][9][10]12 however, none of these options is clinically or economically practical.…”