Radiographic Evaluation of the Normal Distal Tibiofibular Syndesmosis

Abstract

Our data form the basis for revised radiographic criteria to evaluate the distal tibiofibular syndesmosis which may influence clinical management of these patients.

Stable and unstable grade II syndesmotic injuries require different treatment strategies and vary in functional outcomes: a systematic review

“…Previous studies have found great variability in the radiographic measurements in normal syndesmosis,41 42 and MRI studies have demonstrated that the tibiofibular clear space and tibiofibular overlap measurements on radiographs—measurements that are often used to determine instability—did not correlate with syndesmotic ligament injuries 43 44. MRI has been shown to be accurate in identifying a rupture of one or more of the ligaments 45 46.…”

Acute and Chronic Injuries to the Syndesmosis

“…55 Recent studies have found great variability in the radiographic measurements of normal patients. 54,56 A study in patients without known clinical or radiographic evidence of abnormality found that the mean TFCS was 4.6 mm on the AP view and 4.3 mm on the mortise view, whereas the mean TFO was 8.3 mm on the AP view and 3.5 mm on the mortise view. It was also demonstrated that a lack of overlap on the mortise view may represent a normal variant.…”

“…It was also demonstrated that a lack of overlap on the mortise view may represent a normal variant. 56 MRI studies have demonstrated that the TCFS and TFO did not correlate with syndesmotic injury, and MCS greater External rotation stress test for evaluation of a syndesmotic injury. One hand is placed at the mid-calf to stabilize the leg.…”

“…Therefore, because of the variability among different individuals, comparison views of the contralateral extremity and advanced imaging are an important diagnostic tool for confirmation of clinical suspicion of syndesmosis disruption. 56 Although plain weight bearing radiographs can show abnormalities, frank diastasis without fracture or applied stress is a rare occurrence. 54,55,59 External rotation stress or gravity stress views may be used to confirm latent diastasis.…”

Technical Considerations in the Treatment of Syndesmotic Injuries Associated With Ankle Fractures

“…If the contralateral ankle is uninjured, comparison radiographic views should be obtained; comparison of the injured and uninjured ankles is more effective than comparing the injured ankle with standards based on the general population. 20 These views can be obtained with fluoroscopy at the beginning of the surgical procedure, using standard ankle and C-arm positioning. In addition to determining whether an injury is present, these images aid in the assessment of intraoperative reduction.…”