Pediatric Ankle Syndesmosis Injuries

Abstract

Ankle syndesmosis injuries occur in 1% of pediatric ankle trauma. In the younger populations, an open physis has been thought to be a protective factor against syndesmotic injury and therefore favors more Salter-Harris type injuries. Clinical methods used to diagnose syndesmotic injuries may not be effective in the pediatric population. Radiographic findings are mostly based on the study of adolescent and adult populations. Therefore, syndesmotic injuries may be overlooked in the younger pediatric patient with ankle trauma and open physes. Here we present a review of the literature of ankle syndesmotic injuries and demonstrate how isolated injury can be missed in the younger pediatric patient. Further research is needed to fully characterize clinical exam and radiographic findings of syndesmotic injury in the younger pediatric patient and how these may change with time and growth. Key Concepts• Diagnosis of ankle syndesmotic injuries, including isolated injuries, in children is difficult and has different criteria for diagnosis than in adults.• Syndesmotic anatomy changes with growth and false positives or negatives in diagnosis are possible using plain radiographs alone.• Stress radiographs, bilateral radiographs, and MRI imaging should be considered when clinical suspicion is high.• Consider tightrope fixation in lieu of syndesmotic screws as recent literature in adolescents supports it as equivalent or superior regarding patient outcomes.