What Is the Tibiofibular Syndesmosis?

The tibiofibular joint plays an important role in maintaining the stability of the ankle joint, weight transmission and walking, and its injuries are not uncommon. The anterior separation of the tibiofibular joint is often accompanied by distal fibula fractures, tibiofibular fractures, and anterior tibial nodules Fractures such as avulsion fractures, if not treated promptly or improperly, often lead to ankle instability, residual chronic pain, joint instability and traumatic arthritis, which seriously affects ankle function.

Basic Information

Visiting department
orthopedics
Common causes
Caused by pronation-external rotation, pronation-abduction violence
Common symptoms
Local swelling and pain, physical deformity, tenderness and dysfunction
Contagious
no

Causes of anterior tibiofibular joint anterior separation

Usually caused by pronation-external rotation, pronation-abduction type violence, rarely caused by pronation-external type.

Clinical manifestations of anterior tibiofibular combined anterior separation

The patient had a history of trauma, local swelling and pain, and physical abnormalities, tenderness, and dysfunction.

Inferior tibiofibular anterior separation test

X-ray examination and under-stress imaging can indirectly confirm ligament damage and show fractures.

Diagnosis of combined anterior and posterior tibiofibular separation

Diagnosis can be confirmed based on clinical manifestations and related examinations.

Subtibia and fibula combined anterior separation treatment

Non-surgical treatment
For simple tibiofibular ligament injury, only closed reduction and calf plaster fixation are required for 6 to 8 weeks to avoid weight bearing. Most patients have a good prognosis after conservative treatment. Tibial posterior lip avulsion fractures, fracture fragments not exceeding 1/4 of the articular surface, and those who have no effect on the joint, can also be fixed with plaster. For cases with fibula fractures that can be reduced, for example, they can still be fixed with plaster. If the fracture reduction is not satisfactory, the fibula incision and internal fixation should be done. After the fibula is firmly fixed, it should be fixed with calf plaster for 6 to 8 weeks.
2. Surgical treatment
At present, there is still controversy about the surgical indications of the combined tibiofibular internal fixation. Most scholars recommend that the tibiofibular internal fixation should be performed in the following cases: high fibula fractures, such as Maisonneuve fractures, and lower tibiofibular injuries above 4.5cm of the ankle joint surface. The medial structure is damaged and cannot be repaired; at the same time, there are medial ligament rupture, fibula fracture, joint dislocation of the lower tibiofibular joint, and dislocation of the tibiofibular joint; repair of the triangular ligament and fixation of the fibula can not maintain the stability of the lower tibiofibular joint. According to different fracture types, the corresponding method should be adopted.
(1) The fracture is first fixed during the operation, and the anatomical reduction and strong fixation of the fibula fracture is of vital importance.
(2) The optimal position of the tibiofibular joint fixation screw should be 2 ~ 4cm from the tibiofibular joint surface, and implanted at an angle of 25 ° ~ 30 ° from the back to the outside. When accompanied by a high fibula fracture, it is best to fix two screws in parallel, in other cases only one screw is required. Crossing 4 layers of cortex is stronger than 3 layers of cortex, but there is a higher risk of broken nails. In the case of fixing 4 layers of cortex, it is best to remove the screws 6-8 weeks after surgery to prevent nail breakage, and it is not necessary to remove the screws conventionally to fix the 3 layers of cortex.

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