Syndesmosis (high ankle sprain) injury can happen alone or with an ankle fracture.
The ankle joint compromised of 3 bones: tibia – inside portion of ankle; fibula – outer portion of ankle; talus – resting on the calcaneus bone. These three bones mean the ankle has 3 joints. The individual bones are connected by ligaments while tendons attach muscles to bones. Each of these joints provides a different movement of the ankle. The best example is the movement of walking.
When the inside or outside of the ankle gets injured either by a traumatic twisting injury, ‘rolling of the ankle’ or a break in the bone it can cause disruption to the ankle joint / syndesmosis junction. Several different injuries can occur:
- Fracture of the distal fibula / lateral malleolus
- Fracture of the distal tibia / medial malleolus
- Fracture of the distal tibia, fibula AND talus – trimalleolar fracture
- Avulsion fracture of either the fibula / tibia which is where the tendon pulls off a small chip of bone
- Ligament sprain, partial tear or rupture
Typical Treatment Options
These can be treated either conservatively or surgically but any of the afore-mentioned injuries that include syndesmotic injury will require surgical intervention.
Surgical intervention is usually performed at an outpatient surgery center; a hospital is only likely if a patient has considerable health issues or the injury was an open fracture. The surgery, depending on the type of injury, will consist of ‘plates and screws’ and always done with x-rays for accurate placement of the screws and reduction of the fracture. Syndesmosis repair always includes screws going the length of the fibula to the tibia. The picture to the left shows syndemosis repair (arrows) as well as distal tibia repair and in the upper left corner, a repair of a fibula fracture with plate and screws. If there is a ligament of tendon rupture, this is usually repaired at the same time by placing an anchor to the bone that has a suture on the other end that will be sewn into the affected ligament or tendon.
Post-Operation Treatment
Recovery after the surgery will include a short post-operative splint. A post-op appointment will be made for 2 weeks after surgery where the splint and dressings will be removed, and a walker boot, short leg splint, or even a cast will be placed. Sutures / staples usually are removed after 2 or 3 weeks. Recovery will also include for the patient to not put any weight on the affect leg for a good month or more by using a walker, crutches or knee scooter.
Physical therapy will be ordered to help the patient with regaining the range of motion, strength and walking in 1 month or so. At times, another surgery may be needed in 6 – 12 months if range of motion is affected, stiffness of the ankle is present. This surgery is shorter than the original and will consist of removal of the syndesmosis screws which will help maximize the range of motion of the ankle.
Any injury to the bones of the body can exacerbate arthritis in other joints.