The Unstable Syndesmosis

The distal tibiofibular syndesmosis is an important functional structure to maintain ankle stability during weight-bearing and walking. Syndesmotic injuries account for 1–10% of all ankle sprains. They are more common in ankle fractures, found in about 10% of all ankle fractures and 25% of ankle fractures that require surgery. Understanding of the exact anatomy of both the osseous and ligamentous structures is essential for interpretation of plain radiographs, CT and MR images as well as understanding findings of ankle arthroscopy and deciding on the best therapeutic management. While trans-syndesmotic screw fixation remains a common and effective fixation method for syndesmotic injuries, the suture button has the advantage of allowing more physiological motion, and of having a significantly lower incidence of malreduction.