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    Treatment of Neglected Syndesmotic Injuries

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    Mohamed Gouda
    This document discusses the treatment of neglected syndesmotic injuries. It begins by describing the anatomy of the syndesmotic ligament complex. It then discusses the diagnosis of syndesmotic injuries through physical exam findings, radiographic imaging like MRI and CT scans, and stress tests. The document outlines various surgical techniques for treating neglected injuries, including ligamentoplasty, translational osteotomy, and syndesmotic fusion for injuries over 6 months old. It provides an example case of a patient who underwent syndesmotic fusion surgery. In summary, the key points are that injuries under 6-6 months may be treated with repair or reconstruction, while injuries over 6 months often require syndesmotic fusion surgery to

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    Treatment of Neglected Syndesmotic Injuries

    Uploaded by

    Mohamed Gouda
    29 views16 pages
    This document discusses the treatment of neglected syndesmotic injuries. It begins by describing the anatomy of the syndesmotic ligament complex. It then discusses the diagnosis of syndesmotic injuries through physical exam findings, radiographic imaging like MRI and CT scans, and stress tests. The document outlines various surgical techniques for treating neglected injuries, including ligamentoplasty, translational osteotomy, and syndesmotic fusion for injuries over 6 months old. It provides an example case of a patient who underwent syndesmotic fusion surgery. In summary, the key points are that injuries under 6-6 months may be treated with repair or reconstruction, while injuries over 6 months often require syndesmotic fusion surgery to

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    This document discusses the treatment of neglected syndesmotic injuries. It begins by describing the anatomy of the syndesmotic ligament complex. It then discusses the diagnosis of syndesmotic injuries through physical exam findings, radiographic imaging like MRI and CT scans, and stress tests. The document outlines various surgical techniques for treating neglected injuries, including ligamentoplasty, translational osteotomy, and syndesmotic fusion for injuries over 6 months old. It provides an example case of a patient who underwent syndesmotic fusion surgery. In summary, the key points are that injuries under 6-6 months may be treated with repair or reconstruction, while injuries over 6 months often require syndesmotic fusion surgery to

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views16 pages

    Treatment of Neglected Syndesmotic Injuries

    Uploaded by

    Mohamed Gouda
    This document discusses the treatment of neglected syndesmotic injuries. It begins by describing the anatomy of the syndesmotic ligament complex. It then discusses the diagnosis of syndesmotic injuries through physical exam findings, radiographic imaging like MRI and CT scans, and stress tests. The document outlines various surgical techniques for treating neglected injuries, including ligamentoplasty, translational osteotomy, and syndesmotic fusion for injuries over 6 months old. It provides an example case of a patient who underwent syndesmotic fusion surgery. In summary, the key points are that injuries under 6-6 months may be treated with repair or reconstruction, while injuries over 6 months often require syndesmotic fusion surgery to

    Copyright:

    © All Rights Reserved
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    of 16

    TREATMENT OF NEGLECTED

    SYNDESMOTIC INJURIES
    Stephen Schmid DPM
    Chief of Surgery, Lake Region Hospital
    CONFLICTS OF INTEREST
    • None
    ANATOMY
    • Syndesmotic ligament complex
    • Anterior inferior tibiofibular ligament
    (AITFL) – 35%
    • Posterior inferior tibiofibular ligament
    (PITFL) – 42%
    • Interosseous ligament (IL) – 22%
    • Inferior transverse tibiofibular
    ligament *

    Hsu, et al. Syndesmotic injuries in athletes. Op Tech Sports Med. 2014; 22 (4): 270-281.

    Ogilvie-Harris Dj, Reed SC, Hedman TP. Disruption of the ankle syndesmosis: biomechanical study of the ligamentous
    restraints. Arthroscopy .1994 Oct;10(5):558-60.
    DIAGNOSIS
    • Signs and Symptoms:
    • Persistent ankle pain
    • Difficulty with uneven surfaces
    • Sensation of ankle giving way
    • Stiffness
    • Limited dorsiflexion
    DIAGNOSIS
    • Radiographic Exam:
    • Tibiofibular clear space < 6 mm on
    AP and Mortise
    • Tibiofibular overlap
    • AP: >6 mm or >42% width of fibula
    • Mortise: >1 mm
    • Medial clear space ≤ superior clear
    space
    • Advanced Imaging
    • MRI
    • CT

    http://www.cmcedmasters.com/ortho-blog/the-adult-ankle
    DIAGNOSIS
    • Exam
    • External rotation stress test
    • Squeeze test
    • Cotton test
    • Fibula translation test
    • Arthroscopic evaluation

    Johnson ZA, et al. Arthroscopic Stabilization for Chronic Latent Syndesmotic Instability. Arthroscopy Techniques, Vol. 5,
    No 2 (April), 2016: e262-e268
    SURGICAL TECHNIQUES
    LIGAMENTOPLASTY

    Morris, Matthew William John et al. “Distal tibiofibular syndesmosis reconstruction using a free hamstring autograft.”
    Foot & ankle international 30 6 (2009): 506-11.
    TRANSLATIONAL OSTEOTOMY

    Beaumer, et al. Late reconstruction of the anterior distal tibiofibular syndesmosis. Acta Orthop Scand 2000; 71 (5): 519-
    521
    SURGICAL TECHNIQUES
    SYNDESMOTIC FUSION
    • Injuries > 6 months
    • Begin 1 cm proximal to ankle joint
    • 2-3 cm fusion site
    • Bone graft

    Penã FA, Coetzee JC. Ankle Syndesmosis Injuries. Foot Ankle Clin N Am. 11 (2006); 35-50.
    CASE EXAMPLE
    • 44 y/o male
    • Severe ankle sprain 3 years prior
    • Complains of stiffness, pain with
    running and cutting
    • Pain at anterolateral
    ankle/syndesmosis
    • Positive external rotation stress test
    • Abnormal CT scan
    CASE EXAMPLE
    CASE EXAMPLE
    SUMMARY AND PEARLS
    • 6 weeks to 6 months – consider
    repair/reconstruction
    • >6 months – Syndesmotic fusion
    • When performing syndesmotic
    fusion
    • Be aggressive in bone resection
    • Grafting- size matters
    • Avoid malreduction
    THANK YOU

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