mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»mossj-46Research ArticleСтатьиПОКАЗАНИЯ К СТАБИЛИЗАЦИИ МЕЖБЕРЦОВОГО СИНДЕСМОЗАINDICATIONS TO STABILIZATION OF TIBIOFIBULAR SYNDESMOSISЛазкоФ. Л.LazkoF. L.Fedor_lazko@mail.ruКнеллерЛ. О.KnellerL. O.Okneller90gmail.comСеменовА. Ю.SemenovA. Yu.Semeonoff.aleks2011@yandex.ruРомановД. А.RomanovD. A.dr.Romanov67@mail.ruЛазкоМ. Ф.LazkoM. F.maxim_lazko@mail.ruЗагороднийН. В.ZagorodnyN. V.noemail@neicon.ruРоссийский университет дружбы народов, Москва. ГБУЗ ГКБ № 67 им Л.А. ВорохобоваРоссияRUDN university, Vorokhobov City Hospital № 67Russian Federation201731072020061117Copyright © Лазко Ф.Л., Кнеллер Л.О., Семенов А.Ю., Романов Д.А., Лазко М.Ф., Загородний Н.В., 20202020Лазко Ф.Л., Кнеллер Л.О., Семенов А.Ю., Романов Д.А., Лазко М.Ф., Загородний Н.В.Lazko F.L., Kneller L.O., Semenov A.Y., Romanov D.A., Lazko M.F., Zagorodny N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/46

Повреждения межберцового синдесмоза чаще всего происходит при переломе лодыжек, механизм травмы в большинстве случаев пронационно- наружноротационный. Межберцовый синдесмоз окружают важные для стабильности голеностопного сустава связки: передняя межберцовая связка, задняя межберцовая связка и межкостная мембрана. Несмотря на многочисленные биомеханические и клинические исследования, посвященные пере- лому лодыжек, нет единых рекомендаций по вопросу стабилизации межберцового синдесмоза при различных типах переломов.

Tibiofibular syndesmosis is one of the most important stability issues of the talocrural joint. Most commonly tibiofibular syndesmosis becomes damaged in cases of pronation-external rotational mechanism of the malleolar fracture. The issues on the necessity of stabilizing the tibiofibular syndesmosis were repeatedly studied during multiple cadaver and clinical trials, however, no uniform recommendations were formulated at the present moment. The aim of the present review is to formulate the indications for the procedure of tibiofibular syndesmosis stabilization.

перелом лодыжекмежберцовый синдесмозпозиционный винтаnkle fractureTibiofibular syndesmosissyndesmotic screwReferencesWuest TK. Injuries to the distal lower extremity syndesmosis. J Am Acad Orthop Surg 5:172-181, 1997Wuest TK. Injuries to the distal lower extremity syndesmosis. J Am Acad Orthop Surg 5:172-181, 1997Fritschy D. An unusual ankle injury in top skiers. Am J Sports Med 17:282-285, 1989Fritschy D. An unusual ankle injury in top skiers. Am J Sports Med 17:282-285, 1989Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle 10:325-330, 1990Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle 10:325-330, 1990Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med 19:294-298, 1991Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med 19:294-298, 1991Kelikian H, Kelikian AS. Disorders of the Ankle. WB Saunders, Philadelphia, 1985Kelikian H, Kelikian AS. Disorders of the Ankle. WB Saunders, Philadelphia, 1985Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA. The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am 77:847- 856, 1995Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA. The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am 77:847- 856, 1995Van den Bekerom MPJ, Raven EEJ. The distal fascicle of the ante- rior inferior tibiofibular ligament as a cause of tibiotalar impingement syn- drome. A current concepts review. knee Surg Sports Traumatol Arthrosc 154:465- 471, 2007Van den Bekerom MPJ, Raven EEJ. The distal fascicle of the ante- rior inferior tibiofibular ligament as a cause of tibiotalar impingement syn- drome. A current concepts review. knee Surg Sports Traumatol Arthrosc 154:465- 471, 2007Miller CD, Shelton WR, Barrett GR, Savoi FH, Dukes AD. Deltoid and syndesmosis ligament injury of the ankle without fracture. Am J Sports Med 23:746 -750, 1995Miller CD, Shelton WR, Barrett GR, Savoi FH, Dukes AD. Deltoid and syndesmosis ligament injury of the ankle without fracture. Am J Sports Med 23:746 -750, 1995Scranton PE. Isolated syndesmotic injuries: diastasis of the ankle in the athlete. Tech Foot Ankle Surg 1:88-93, 2002Scranton PE. Isolated syndesmotic injuries: diastasis of the ankle in the athlete. Tech Foot Ankle Surg 1:88-93, 2002Thomas KA, Harris MB, Willis MC, Lu Y, MacEwen GD. The ef- fects of the interosseous membrane and partial fibulectomy on loading of the tibia: a biomechanical study. Orthopedics 18:373-383, 1995Thomas KA, Harris MB, Willis MC, Lu Y, MacEwen GD. The ef- fects of the interosseous membrane and partial fibulectomy on loading of the tibia: a biomechanical study. Orthopedics 18:373-383, 1995Bartonicek J. Anatomy of the tibiofibular syndesmosis and its clini- cal relevance. Surg Radiol Anat 25:379 -386, 2003Bartonicek J. Anatomy of the tibiofibular syndesmosis and its clini- cal relevance. Surg Radiol Anat 25:379 -386, 2003Boden SD, Labropaulos PA, McCowin P, Lestini WF, Hurwitz SR. Mechanical considerations for the syndesmosis screw. J Bone Joint Surg 71A:1548, 1989Boden SD, Labropaulos PA, McCowin P, Lestini WF, Hurwitz SR. Mechanical considerations for the syndesmosis screw. J Bone Joint Surg 71A:1548, 1989Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am 38A:761-781, 1956Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am 38A:761-781, 1956Rasmussen O, Tovborg-Jensen I, Boe S. Distal tibiofibular liga- ments. Analysis of function. Acta Orthop Scand 53:681-686, 1982Rasmussen O, Tovborg-Jensen I, Boe S. Distal tibiofibular liga- ments. Analysis of function. Acta Orthop Scand 53:681-686, 1982Grath G. Widening of the ankle mortise: a clinical and experimen- tal study. Act Chir Scand Suppl 263:1-88, 1960Grath G. Widening of the ankle mortise: a clinical and experimen- tal study. Act Chir Scand Suppl 263:1-88, 1960Peter RE, Harrington RM, Henley MB, Tencer AF. Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: com- parison of two techniques. J Orthop Trauma 8:215-219, 1994Peter RE, Harrington RM, Henley MB, Tencer AF. Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: com- parison of two techniques. J Orthop Trauma 8:215-219, 1994Scranton PE, McMaster J, Kelly E. Dynamic fibular functions. Clin Orthop 188:76 - 81, 1976Scranton PE, McMaster J, Kelly E. Dynamic fibular functions. Clin Orthop 188:76 - 81, 1976Minns RJ, Hunter JAA. The mechanical and structural characteris- tics of the tibiofibular interosseous membrane. Acta Orthop Scand 47: 236 -240, 1976Minns RJ, Hunter JAA. The mechanical and structural characteris- tics of the tibiofibular interosseous membrane. Acta Orthop Scand 47: 236 -240, 1976Skraba JS, Greenwald AS. The role of the interosseous membrane on tibiofibular weightbearing. Foot Ankle 4:301-304, 1984Skraba JS, Greenwald AS. The role of the interosseous membrane on tibiofibular weightbearing. Foot Ankle 4:301-304, 1984Vukicevic S, Stern-Padovan R, Vukicevic D, Keros P. Holographic investigations of the human tibiofibular interosseous membrane. Clin Or- thop 151:210 -214, 1980Vukicevic S, Stern-Padovan R, Vukicevic D, Keros P. Holographic investigations of the human tibiofibular interosseous membrane. Clin Or- thop 151:210 -214, 1980Takebe K, Nakagawa A, Minami H, Kanazawa H, Hirohata K. Role of the fibula in weightbearing. Clin Orthop 184:289-292, 1984Takebe K, Nakagawa A, Minami H, Kanazawa H, Hirohata K. Role of the fibula in weightbearing. Clin Orthop 184:289-292, 1984Riegels-Nielsen P, Greiff J. The stability of the tibiofibular syndes- mosis following rigid internal fixation for type C malleolar fractures: an experimental and clinical study. Injury 14:357-360, 1983Riegels-Nielsen P, Greiff J. The stability of the tibiofibular syndes- mosis following rigid internal fixation for type C malleolar fractures: an experimental and clinical study. Injury 14:357-360, 1983Jensen SL, Andresen BK, Mencke S, Nielsen PT. Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aal- borg, Denmark. Acta Orthop Scand 69:48-50, 1998Jensen SL, Andresen BK, Mencke S, Nielsen PT. Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aal- borg, Denmark. Acta Orthop Scand 69:48-50, 1998Thordarson DB, Hedman TP, Gross D, Magre G. Biomechanical evaluation of polylactide absorbable screws used for syndesmosis injury repair. Foot Ankle Int 18:622-627, 1997Thordarson DB, Hedman TP, Gross D, Magre G. Biomechanical evaluation of polylactide absorbable screws used for syndesmosis injury repair. Foot Ankle Int 18:622-627, 1997Seitz WH Jr, Bachner EJ, Abram LJ, Postak P, Polando G, Brooks DB, Greenwald AS. Repair of the tibiofibular syndesmosis with a flexible implant. J Orthop Trauma 51:78 - 82, 1991Seitz WH Jr, Bachner EJ, Abram LJ, Postak P, Polando G, Brooks DB, Greenwald AS. Repair of the tibiofibular syndesmosis with a flexible implant. J Orthop Trauma 51:78 - 82, 1991Court-Brown CM, McBirnie J, Wilson G: Adult ankle fractures: an increasing problem? Acta Orthop Scand 69:43-47, 1998Court-Brown CM, McBirnie J, Wilson G: Adult ankle fractures: an increasing problem? Acta Orthop Scand 69:43-47, 1998Kennedy JG, Johnson SM, Collins AL, DalloVedova P, McManus WF, Hynes DM, Walsh MG, Stephens MM. An evaluation of the Weber classification of ankle fractures. Injury 29:577-580, 1998Kennedy JG, Johnson SM, Collins AL, DalloVedova P, McManus WF, Hynes DM, Walsh MG, Stephens MM. An evaluation of the Weber classification of ankle fractures. Injury 29:577-580, 1998Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe LB. Quan- titative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg 65A:667-677, 1983Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe LB. Quan- titative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg 65A:667-677, 1983Guise ER. Rotational ligamentous injuries to the ankle in football. Am J Sports Med 4:1- 6, 1976Guise ER. Rotational ligamentous injuries to the ankle in football. Am J Sports Med 4:1- 6, 1976Lauge-Hansen N. Fractures of the ankle II. Combined experimen- talsurgical and experimental-roentgenologic investigations. Arch Surg 60:957-985, 1950Lauge-Hansen N. Fractures of the ankle II. Combined experimen- talsurgical and experimental-roentgenologic investigations. Arch Surg 60:957-985, 1950Joy G, Patzakis MJ, Harvey JP Jr. Precise evaluation of the reduc- tion of severe ankle fractures. Technique and correlation with end results. J Bone Joint Surg 58A:979 -993, 1974Joy G, Patzakis MJ, Harvey JP Jr. Precise evaluation of the reduc- tion of severe ankle fractures. Technique and correlation with end results. J Bone Joint Surg 58A:979 -993, 1974Bolin H. The fibula and its relationship to the tibia and talus in in- juries of the ankle due to forced external rotation. Acta Radiol 56:439 - 448, 1962Bolin H. The fibula and its relationship to the tibia and talus in in- juries of the ankle due to forced external rotation. Acta Radiol 56:439 - 448, 1962Chissell HR, Jones J. The influence of diastasis screws on the out- come of Weber C ankle fractures. J Bone Joint Surg Br 773:435- 438, 1995Chissell HR, Jones J. The influence of diastasis screws on the out- come of Weber C ankle fractures. J Bone Joint Surg Br 773:435- 438, 1995Harper MC, Keller TS. A radiographic evaluation of the tibiofibu- lar syndesmosis. Foot Ankle 10:156 -160, 1989Harper MC, Keller TS. A radiographic evaluation of the tibiofibu- lar syndesmosis. Foot Ankle 10:156 -160, 1989Jenkinson RJ, Sanders DW, Macleod MD, Domonkos A, Lyd- estadt J. Intraoperative diagnosis of syndesmosis injuries in external rota- tion ankle fractures. J Orthop Trauma 199:604 - 609, 2005Jenkinson RJ, Sanders DW, Macleod MD, Domonkos A, Lyd- estadt J. Intraoperative diagnosis of syndesmosis injuries in external rota- tion ankle fractures. J Orthop Trauma 199:604 - 609, 2005Lindsjö U. Operative treatment of ankle fractures. Acta Orthop Scand Suppl 52:1-131, 1981. 37. Pankovich AM. Maisonneuve fracture of the fibula. J Bone Joint Surg 58A:337-342, 1976. Nielson JH, Sallis JG, Potter HG, Helfet DL, Lorich DG. Corre- lation of interosseous membrane tears to the level of the fibular fracture. J Orthop Trauma 182:68 -74, 2004Lindsjö U. Operative treatment of ankle fractures. Acta Orthop Scand Suppl 52:1-131, 1981. 37. Pankovich AM. Maisonneuve fracture of the fibula. J Bone Joint Surg 58A:337-342, 1976. Nielson JH, Sallis JG, Potter HG, Helfet DL, Lorich DG. Corre- lation of interosseous membrane tears to the level of the fibular fracture. J Orthop Trauma 182:68 -74, 2004Pankovich AM. Fractures of the fibula proximal to the distal tibio- fibular syndesmosis. J Bone Joint Surg 60A:221-229, 1978Pankovich AM. Fractures of the fibula proximal to the distal tibio- fibular syndesmosis. J Bone Joint Surg 60A:221-229, 1978Ebraheim NA, Elgafy H, Padanilam T. Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res 409:260 -267, 2003Ebraheim NA, Elgafy H, Padanilam T. Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res 409:260 -267, 2003Stiehl JB. Complex ankle fracture dislocations with syndesmotic diastasis. Orthop Rev 19:499 -507, 1990Stiehl JB. Complex ankle fracture dislocations with syndesmotic diastasis. Orthop Rev 19:499 -507, 1990Amendola A. Controversies in diagnosis and management of syn- desmosis injuries of the ankle. Foot Ankle 13:44-50, 1992Amendola A. Controversies in diagnosis and management of syn- desmosis injuries of the ankle. Foot Ankle 13:44-50, 1992Whittle AP. Fractures of the lower extremity. In Campbell’s Ope- rative Orthopaedics, ed 39, pp 2046-2048, edited by ST Canale, St Louis. Mosby, 1998Whittle AP. Fractures of the lower extremity. In Campbell’s Ope- rative Orthopaedics, ed 39, pp 2046-2048, edited by ST Canale, St Louis. Mosby, 1998Müller ME, Algöwer M, Schneider R, et al. Malleolar fractures. In Manual of Internal Fixation, ed 3, pp 595-612, Springer-Verlag, 1991Müller ME, Algöwer M, Schneider R, et al. Malleolar fractures. In Manual of Internal Fixation, ed 3, pp 595-612, Springer-Verlag, 1991Lui TH, Ip K, Chow HT. Comparison of radiologic and ar- throscopic diagnoses of distal tibiofibular syndesmosis disruption in acute ankle fracture. Arthroscopy 21(11):1370, 2005Lui TH, Ip K, Chow HT. Comparison of radiologic and ar- throscopic diagnoses of distal tibiofibular syndesmosis disruption in acute ankle fracture. Arthroscopy 21(11):1370, 2005Jenkinson RJ, Sanders DW, Macleod MD, Domonkos A, Lyd- estadt J. Intraoperative diagnosis of syndesmosis injuries in external rota- tion ankle fractures. J Orthop Trauma 199:604 - 609, 2005Jenkinson RJ, Sanders DW, Macleod MD, Domonkos A, Lyd- estadt J. Intraoperative diagnosis of syndesmosis injuries in external rota- tion ankle fractures. J Orthop Trauma 199:604 - 609, 2005Candal-Couto JJ, Burrow D, Bromage S, Briggs PJ. Instability of the tibio-fibular syndesmosis: have we been pulling in the wrong direction? Injury 358:814 - 818, 2004Candal-Couto JJ, Burrow D, Bromage S, Briggs PJ. Instability of the tibio-fibular syndesmosis: have we been pulling in the wrong direction? Injury 358:814 - 818, 2004Mizel MS. Technique tip: a revised method of the Cotton test for intra-operative evaluation of syndesmotic injuries. Foot Ankle Clin 24:86 - 87, 2003Mizel MS. Technique tip: a revised method of the Cotton test for intra-operative evaluation of syndesmotic injuries. Foot Ankle Clin 24:86 - 87, 2003Sclafani SJA. Ligamentous injury of the lower tibiofibular syndes- mosis: radiographic evidence. Radiology 156:21-27, 1985Sclafani SJA. Ligamentous injury of the lower tibiofibular syndes- mosis: radiographic evidence. Radiology 156:21-27, 1985Van den Bekerom MPJ, Raven EEJ. Review of operative techniques for stabilising the distal tibiofibular syndesmosis. Foot Ankle Int. In pressVan den Bekerom MPJ, Raven EEJ. Review of operative techniques for stabilising the distal tibiofibular syndesmosis. Foot Ankle Int. In pressKaukonen JP, Lamberg T, Korkala O, Pajarinen J. Fixation of syn- desmotic ruptures in 38 patients with a malleolar fracture: a randomized study comparing a metallic and a bioabsorbable screw. J Orthop Trauma 196:392-395, 2005Kaukonen JP, Lamberg T, Korkala O, Pajarinen J. Fixation of syn- desmotic ruptures in 38 patients with a malleolar fracture: a randomized study comparing a metallic and a bioabsorbable screw. J Orthop Trauma 196:392-395, 2005Cox S, Mukherjee DP, Ogden AL, Mayuex RH, Sadasivan KK, Albright JA, Pietrzak WS. Distal tibiofibular syndesmosis fixation: a ca- daveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation. J Foot Ankle Surg 442:144 -151, 2005Cox S, Mukherjee DP, Ogden AL, Mayuex RH, Sadasivan KK, Albright JA, Pietrzak WS. Distal tibiofibular syndesmosis fixation: a ca- daveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation. J Foot Ankle Surg 442:144 -151, 2005Korkala O, Kiljunen V, Salminen S, Kuokkanen H, Niskanen R. Biodegradable screw fixation of the syndesmosis together with metal- lic osteosynthesis. Preliminary experience of 7 ankles. Ann Chir Gynaecol 884:295-297, 1999Korkala O, Kiljunen V, Salminen S, Kuokkanen H, Niskanen R. Biodegradable screw fixation of the syndesmosis together with metal- lic osteosynthesis. Preliminary experience of 7 ankles. Ann Chir Gynaecol 884:295-297, 1999Miller SD, Carls RJ. The bioresorbable syndesmotic screw: appli- cation of polymer technology in ankle fractures. Am J Orthop 31(1 Sup- pl):18-21, 2002Miller SD, Carls RJ. The bioresorbable syndesmotic screw: appli- cation of polymer technology in ankle fractures. Am J Orthop 31(1 Sup- pl):18-21, 2002Hovis WD, Kaiser BW, Watson JT, Bucholz RW. Treatment of syn- desmotic disruptions of the ankle with bioabsorbable screw fixation. J Bone Joint Surg Am 84A1:26-31, 2002Hovis WD, Kaiser BW, Watson JT, Bucholz RW. Treatment of syn- desmotic disruptions of the ankle with bioabsorbable screw fixation. J Bone Joint Surg Am 84A1:26-31, 2002Sinisaari IP, Luthje PM, Mikkonen RH. Ruptured tibiofibular syndesmosis: comparison study of metallic to bioabsorbable fixation. Foot Ankle Int 238:744-748, 2002Sinisaari IP, Luthje PM, Mikkonen RH. Ruptured tibiofibular syndesmosis: comparison study of metallic to bioabsorbable fixation. Foot Ankle Int 238:744-748, 2002Thordarson DB, Samuelson M, Shepherd LE, Merkle PF, Lee J. Bioabsorbable versus stainless steel screw fixation of the syndesmosis in pronation-lateral rotation ankle fractures: a prospective randomized trial. Foot Ankle Int 224:335-338, 2001Thordarson DB, Samuelson M, Shepherd LE, Merkle PF, Lee J. Bioabsorbable versus stainless steel screw fixation of the syndesmosis in pronation-lateral rotation ankle fractures: a prospective randomized trial. Foot Ankle Int 224:335-338, 2001Yde J, Kristensen KD. Inferior tibio-fibular diastasis treated by staple fixation. J Trauma 21:483-485, 1981Yde J, Kristensen KD. Inferior tibio-fibular diastasis treated by staple fixation. J Trauma 21:483-485, 1981Cedell CA, Wiberg G. Treatment of eversion-supination fractures of the ankle (2de degree). Acta Chir Scand 124:41-44, 1962Cedell CA, Wiberg G. Treatment of eversion-supination fractures of the ankle (2de degree). Acta Chir Scand 124:41-44, 1962ElRayes M, Hammoda A. Screw versus staple in stabilization of diastasis of tibiofibular syndesmosis. J Foot Ankle Surg 131:5-9, 2007ElRayes M, Hammoda A. Screw versus staple in stabilization of diastasis of tibiofibular syndesmosis. J Foot Ankle Surg 131:5-9, 2007Marqueen T, Owen J, Nicandri G, Wayne J, Carr J. Comparison of the syndesmotic staple to the transsyndesmotic screw: a biomechanical study. Foot Ankle Int 263:224-230, 2005Marqueen T, Owen J, Nicandri G, Wayne J, Carr J. Comparison of the syndesmotic staple to the transsyndesmotic screw: a biomechanical study. Foot Ankle Int 263:224-230, 2005vRelwani J, Lahoti O, Orakwe S. Ilizarov ring fixator for a difficult case of ankle syndesmosis disruption. J Foot Ankle Surg 415:335- 337, 2002vRelwani J, Lahoti O, Orakwe S. Ilizarov ring fixator for a difficult case of ankle syndesmosis disruption. J Foot Ankle Surg 415:335- 337, 2002Thornes B, Walsh A, Hislop M, et al. Suture-endobutton fixation of ankle tibiofibular diastasis: a cadaver study. Foot Ankle Int 242:142- 146, 2003Thornes B, Walsh A, Hislop M, et al. Suture-endobutton fixation of ankle tibiofibular diastasis: a cadaver study. Foot Ankle Int 242:142- 146, 2003Thornes B, Walsh A, Hislop M, Murray P, O’Brien M. Sutureen- dobutton fixation of ankle tibiofibular diastasis: a cadaver study. Foot Ankle Int 242:142-146, 2003Thornes B, Walsh A, Hislop M, Murray P, O’Brien M. Sutureen- dobutton fixation of ankle tibiofibular diastasis: a cadaver study. Foot Ankle Int 242:142-146, 2003Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Su- turebutton syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res 431:207-212, 2005Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Su- turebutton syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res 431:207-212, 2005FarhanMJ, SmithTW. Fixation of diastasis of the inferiortibiofibular joint using the syndesmosis hook. Injury 165:309-311, 1985FarhanMJ, SmithTW. Fixation of diastasis of the inferiortibiofibular joint using the syndesmosis hook. Injury 165:309-311, 1985Engelbrecht E. Die Versorgung Tibio-fibular Syndesmosenspren- gungen mit dem Syndesmosen-Haken. Chirurg 42:92, 1971Engelbrecht E. Die Versorgung Tibio-fibular Syndesmosenspren- gungen mit dem Syndesmosen-Haken. Chirurg 42:92, 1971Engelbrecht E, Engelbrecht H, Huynh PL. Experiences with the syndesmotic hook in tibiofibular ligament injuries. Der Chirurg 5511: 749-755, 1984Engelbrecht E, Engelbrecht H, Huynh PL. Experiences with the syndesmotic hook in tibiofibular ligament injuries. Der Chirurg 5511: 749-755, 1984Grady JF, Moore CJ, O’Connor KJ, La Montagne D. The use of a transsyndesmotic bolt in the treatment of tibiofibular diastasis: two case studies. J Foot Ankle Surg 346:571-576, 1995Grady JF, Moore CJ, O’Connor KJ, La Montagne D. The use of a transsyndesmotic bolt in the treatment of tibiofibular diastasis: two case studies. J Foot Ankle Surg 346:571-576, 1995Burns BH. Diastasis of the inferior tibiofibular joint. Proc Roy Soc Med 36:330-332, 1942-1943Burns BH. Diastasis of the inferior tibiofibular joint. Proc Roy Soc Med 36:330-332, 1942-1943Fusi F. La diastasi tibio-peroneale inferior. Minerva Ortop 7:450- 485, 1956Fusi F. La diastasi tibio-peroneale inferior. Minerva Ortop 7:450- 485, 1956Pagani A, Ronco G. Il cachiaggio trans-osseo con filo metalico nel trattamento della diastasi della sundesmosi tibio-peroneale. Minerva Ortop 31:149 -158, 1980Pagani A, Ronco G. Il cachiaggio trans-osseo con filo metalico nel trattamento della diastasi della sundesmosi tibio-peroneale. Minerva Ortop 31:149 -158, 1980Kabukcuoglu Y, Kucukkaya M, Eren T, Gorgec M, Kuzgun U. The Ank device: a new approach in the treatment of the fractures of the lateral malleolus associated with the rupture of the syndesmosis. Foot Ankle Int 219:753-758, 2000Kabukcuoglu Y, Kucukkaya M, Eren T, Gorgec M, Kuzgun U. The Ank device: a new approach in the treatment of the fractures of the lateral malleolus associated with the rupture of the syndesmosis. Foot Ankle Int 219:753-758, 2000Kara AN. A biomechanical experimental study on the stability of syndesmosis ligaments of the ankle and the results of the treatment by a new osteosynthesis device we have applied to diastasis of traumatic tibio- fibular syndesmosis. Thesis, Istanbul, 1982Kara AN. A biomechanical experimental study on the stability of syndesmosis ligaments of the ankle and the results of the treatment by a new osteosynthesis device we have applied to diastasis of traumatic tibio- fibular syndesmosis. Thesis, Istanbul, 1982Kara AN, Esenyel CZ, Sener BT, Merih E. A different approach to the treatment of the lateral malleolar fractures with syndesmosis injury: the Ank nail. J Foot Ankle Surg 386:394 - 402, 1999Kara AN, Esenyel CZ, Sener BT, Merih E. A different approach to the treatment of the lateral malleolar fractures with syndesmosis injury: the Ank nail. J Foot Ankle Surg 386:394 - 402, 1999Grass R, Rammelt S, Biewener A, Zwipp H. Peroneus longus liga- mentoplasty for chronic instability of the distal tibiofibular syndesmosis. Foot Ankle Int 24:392-397, 2003Grass R, Rammelt S, Biewener A, Zwipp H. Peroneus longus liga- mentoplasty for chronic instability of the distal tibiofibular syndesmosis. Foot Ankle Int 24:392-397, 2003Bai XD, Xing GY, Yang CD, Ye QB. Operative treatment for separa- tion of distal tibiofibular syndesmosis. Chin J Traumatol 93: 175-180, 2006Bai XD, Xing GY, Yang CD, Ye QB. Operative treatment for separa- tion of distal tibiofibular syndesmosis. Chin J Traumatol 93: 175-180, 2006Beumer A, Heijboer RP, Fontijne WP, Swierstra BA. Late recon- struction of the anterior distal tibiofibular syndesmosis. Good outcome in 9 patients. Acta Orthop Scand 715:519-521, 2000Beumer A, Heijboer RP, Fontijne WP, Swierstra BA. Late recon- struction of the anterior distal tibiofibular syndesmosis. Good outcome in 9 patients. Acta Orthop Scand 715:519-521, 2000Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg 47B:634-660, 1965Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg 47B:634-660, 1965De Souza LJ, Gustilo RB, Meyer TJ. Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg Am 67:1066-1074, 1985De Souza LJ, Gustilo RB, Meyer TJ. Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg Am 67:1066-1074, 1985Olerud C. The effects of the syndesmotic screw on the extension capacity of the ankle joint. Arch Orthop Trauma Surg 104:299-304, 1985Olerud C. The effects of the syndesmotic screw on the extension capacity of the ankle joint. Arch Orthop Trauma Surg 104:299-304, 1985Solonen KA, Lauttamus L. Operative treatment of ankle fractures. Acta Orthop Scand 39:223-237, 1968Solonen KA, Lauttamus L. Operative treatment of ankle fractures. Acta Orthop Scand 39:223-237, 1968Yde J, Kristensen KD. Inferior tibio-fibular diastasis treated by staple fixation. J Trauma 21:483-485, 1981Yde J, Kristensen KD. Inferior tibio-fibular diastasis treated by staple fixation. J Trauma 21:483-485, 1981Colton CL. The treatment of Dupuytren’s fracture-dislocation of the ankle. J Bone Joint Surg 53-B(1):63-71, 1971Colton CL. The treatment of Dupuytren’s fracture-dislocation of the ankle. J Bone Joint Surg 53-B(1):63-71, 1971McMaster J, Scranton PE. Tibiofibular synostosis. Clin Orthop III: 172, 1975McMaster J, Scranton PE. Tibiofibular synostosis. Clin Orthop III: 172, 1975Kaye RA. Stabilization of ankle syndesmosis injuries with a syndes- mosis screw. Foot Ankle 9:290-293, 1989Kaye RA. Stabilization of ankle syndesmosis injuries with a syndes- mosis screw. Foot Ankle 9:290-293, 1989Stiehl JB, Needleman RR, Skrade DA. The biomechanical effect of the syndesmotic screw on ankle motion. AO/ASIF Dialogue 22:1-3, 1989Stiehl JB, Needleman RR, Skrade DA. The biomechanical effect of the syndesmotic screw on ankle motion. AO/ASIF Dialogue 22:1-3, 1989Taylor DC, Englehardt DL, Bassett FH III. Syndesmosis sprains of the ankle: the influence of heterotopic calcification. Am J Sports Med 20:146-150, 1992Taylor DC, Englehardt DL, Bassett FH III. Syndesmosis sprains of the ankle: the influence of heterotopic calcification. Am J Sports Med 20:146-150, 1992Albers GH, de Kort AF, Middendorf PR, van Dijk CN. Distal tib- iofibular synostosis after ankle fracture. A 14-year follow-up study. J Bone Joint Surg Br 78:250-252, 1996Albers GH, de Kort AF, Middendorf PR, van Dijk CN. Distal tib- iofibular synostosis after ankle fracture. A 14-year follow-up study. J Bone Joint Surg Br 78:250-252, 1996Karlsson J, Rudholm O, Bergsten T, Faxén E, Styf J. Early range of motion training after ligament reconstruction of the ankle joint. knee Surg Traumatol Arthrosc 3:173-177, 1995Karlsson J, Rudholm O, Bergsten T, Faxén E, Styf J. Early range of motion training after ligament reconstruction of the ankle joint. knee Surg Traumatol Arthrosc 3:173-177, 1995Weening B, Bhandari M. Predictors of functional outcome follow- ing trans-syndesmotic screw fixation of ankle fractures. J Orthop Trauma 192:102-108, 2005Weening B, Bhandari M. Predictors of functional outcome follow- ing trans-syndesmotic screw fixation of ankle fractures. J Orthop Trauma 192:102-108, 2005Mast JW, Teipner WA. A reproducible approach to internal fixation of adult ankle fractures, rationale, technique, and early results. Orthop Clin north Am 11:661-679, 1980Mast JW, Teipner WA. A reproducible approach to internal fixation of adult ankle fractures, rationale, technique, and early results. Orthop Clin north Am 11:661-679, 1980Burns WC 2nd, Prakash K, Adelaar R, Beaudoin A, Krause W. Tibiotalar joint dynamics: indications for the syndesmotic screw-a cadav- eric study. Foot Ankle 143:153-158, 1993Burns WC 2nd, Prakash K, Adelaar R, Beaudoin A, Krause W. Tibiotalar joint dynamics: indications for the syndesmotic screw-a cadav- eric study. Foot Ankle 143:153-158, 1993Purvis GD. Displaced unstable ankle fractures. Classification, incidence, and management of a consecutive series. Clin Orthop 165: 91-98, 1982Purvis GD. Displaced unstable ankle fractures. Classification, incidence, and management of a consecutive series. Clin Orthop 165: 91-98, 1982Wilson FC Jr, Skilbred LA. Long term results in the treatment of displaced bimalleolar fractures. J Bone Joint Surg 48-A:1065-1078, 1966Wilson FC Jr, Skilbred LA. Long term results in the treatment of displaced bimalleolar fractures. J Bone Joint Surg 48-A:1065-1078, 1966Kennedy JG, Soffe KE, Dalla Vedova P, Stephens MM, O’Brien T, Walsh MG, McManus F. Evaluation of the syndesmotic screw in low Weber C ankle fractures. J Orthop Trauma 145:359-366, 2000Kennedy JG, Soffe KE, Dalla Vedova P, Stephens MM, O’Brien T, Walsh MG, McManus F. Evaluation of the syndesmotic screw in low Weber C ankle fractures. J Orthop Trauma 145:359-366, 2000Wyss C, Zollinger H. The cause of subsequent arthrodesis of the ankle joint. Acta Orthop Belg Suppl 57:22-27, 1991Wyss C, Zollinger H. The cause of subsequent arthrodesis of the ankle joint. Acta Orthop Belg Suppl 57:22-27, 1991Yablon I. Reduction of displaced bimalleolar ankle fractures. In- struction Course lectures of the American Academy of Orthopedics, vol 28, St Louis, C.V. Mosby, 1979Yablon I. Reduction of displaced bimalleolar ankle fractures. In- struction Course lectures of the American Academy of Orthopedics, vol 28, St Louis, C.V. Mosby, 1979Yablon I, Heller F, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg 59A:169-173, 1977Yablon I, Heller F, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg 59A:169-173, 1977Ramsey P, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg 58A:356-357, 1976Ramsey P, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg 58A:356-357, 1976Mont MA, Sedlin ED, Weiner LS, Miller AR. Postoperative ra- diographs as predictor of clinical outcome in unstable ankle fractures. J Orthop Trauma 6:652-657, 1992Mont MA, Sedlin ED, Weiner LS, Miller AR. Postoperative ra- diographs as predictor of clinical outcome in unstable ankle fractures. J Orthop Trauma 6:652-657, 1992Yamaguchi K, Martin CH, Boden SD. Operative treatment of syndesmotic disruptions without use of a syndesmotic screw: a prospective clinical study. Foot Ankle Int 158:407-414, 1994Yamaguchi K, Martin CH, Boden SD. Operative treatment of syndesmotic disruptions without use of a syndesmotic screw: a prospective clinical study. Foot Ankle Int 158:407-414, 1994Zindrick MR, Hopkins GE, Knight GW. The effects of lateral talar shift upon the biomechanics of the ankle joint. Orthop Trans 9:332- 333, 1985Zindrick MR, Hopkins GE, Knight GW. The effects of lateral talar shift upon the biomechanics of the ankle joint. Orthop Trans 9:332- 333, 1985Klossner O. Late results of operative and non-operative treatment of severe ankle fractures. Acta Chir Scand 293(Suppl):1-193, 1962.Klossner O. Late results of operative and non-operative treatment of severe ankle fractures. Acta Chir Scand 293(Suppl):1-193, 1962.Pereira DS, Koval KJ, Resnick RB, Sheskier SC, Kummer F, Zuckerman JD. Tibiotalar contact area and pressure distribution: the effect of mortise widening and syndesmosis fixation. Foot Ankle Int 17: 269-274, 1996Pereira DS, Koval KJ, Resnick RB, Sheskier SC, Kummer F, Zuckerman JD. Tibiotalar contact area and pressure distribution: the effect of mortise widening and syndesmosis fixation. Foot Ankle Int 17: 269-274, 1996Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe LB. Quan- titative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am 65:667-677, 1983Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe LB. Quan- titative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am 65:667-677, 1983Roberts RS. Surgical treatment of displaced ankle fractures. Clin Orthop 172:164-170, 1983Roberts RS. Surgical treatment of displaced ankle fractures. Clin Orthop 172:164-170, 1983Veltri DM, Pagnani MJ, O’Brien SJ, Warren RF, Ryan MD, Barnes RP. Symptomatic ossification of the tibiofibular syndesmosis in professional football players: a sequela of the syndesmotic ankle sprain. Foot Ankle Int 16:285-290, 1995Veltri DM, Pagnani MJ, O’Brien SJ, Warren RF, Ryan MD, Barnes RP. Symptomatic ossification of the tibiofibular syndesmosis in professional football players: a sequela of the syndesmotic ankle sprain. Foot Ankle Int 16:285-290, 1995Leeds HC, Ehrlich MG. Instability of the distal tibiofibular syn- desmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am 664:490-503, 1984Leeds HC, Ehrlich MG. Instability of the distal tibiofibular syn- desmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am 664:490-503, 1984Attarian D, Devito D, Garret W. A biomechanical study of hu- man ankle ligaments and autogenous reconstructive grafts. Surg Rounds Orthop 24-27, 1987Attarian D, Devito D, Garret W. A biomechanical study of hu- man ankle ligaments and autogenous reconstructive grafts. Surg Rounds Orthop 24-27, 1987Attarian DE, McCrackin HJ, Devito DP, McElhaney JH, Garrett WE Jr. A biomechanical study of human ankle ligaments and autogenous reconstructive grafts. Am J Sports Med 13:377-381, 1985Attarian DE, McCrackin HJ, Devito DP, McElhaney JH, Garrett WE Jr. A biomechanical study of human ankle ligaments and autogenous reconstructive grafts. Am J Sports Med 13:377-381, 1985Phillips R, Balmer G, Monk C. The external rotation fracture of the fibular malleolus. Br J Surg 56:801-806, 1969Phillips R, Balmer G, Monk C. The external rotation fracture of the fibular malleolus. Br J Surg 56:801-806, 1969Solari J, Benjamin J, Wilson J, Lee R, Pitt M. Ankle mortise sta- bility in Weber C fractures: indications for syndesmotic fixation. J Orthop Trauma 52:190 -195, 1991Solari J, Benjamin J, Wilson J, Lee R, Pitt M. Ankle mortise sta- bility in Weber C fractures: indications for syndesmotic fixation. J Orthop Trauma 52:190 -195, 1991Parfenchuck TA, Frix JM, Bertrand SL, Corpe RS. Clinical use of a syndesmotic screw in stage IV pronation-external rotation ankle frac- tures. Orthop Rev Suppl:23-28, 1994Parfenchuck TA, Frix JM, Bertrand SL, Corpe RS. Clinical use of a syndesmotic screw in stage IV pronation-external rotation ankle frac- tures. Orthop Rev Suppl:23-28, 1994Michelson JD, Waldman B. An axially loaded model of the ankle after pronation external rotation injury. Clin Orthop Relat Res Jul(328):285-293, 1996Michelson JD, Waldman B. An axially loaded model of the ankle after pronation external rotation injury. Clin Orthop Relat Res Jul(328):285-293, 1996Snedden MH, Shea JP. Diastasis with low distal fibula fractures: an anatomic rationale. Clin Orthop Relat Res 382:197-205, 2001Snedden MH, Shea JP. Diastasis with low distal fibula fractures: an anatomic rationale. Clin Orthop Relat Res 382:197-205, 2001Harper MC, Hardin G. Posterior malleolar fractures of the ankle associated with external rotation-abduction injuries. Results with and with- out internal fixation. J Bone Joint Surg 70:1348-1356, 1988Harper MC, Hardin G. Posterior malleolar fractures of the ankle associated with external rotation-abduction injuries. Results with and with- out internal fixation. J Bone Joint Surg 70:1348-1356, 1988Scheidt KB, Stiehl JB, Skrade DA, Barnhardt T. Posterior mal- leolar ankle fractures: an in vitro biomechanical analysis of stability in the loaded and unloaded states. J Orthop Trauma 6:96-101, 1992Scheidt KB, Stiehl JB, Skrade DA, Barnhardt T. Posterior mal- leolar ankle fractures: an in vitro biomechanical analysis of stability in the loaded and unloaded states. J Orthop Trauma 6:96-101, 1992Hartford JM, Gorczyca JT, McNamara JL, Mayor MB. Tibiotalar contact area: contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res 320:182-187, 1995Hartford JM, Gorczyca JT, McNamara JL, Mayor MB. Tibiotalar contact area: contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res 320:182-187, 1995Heim UF. Trimalleolar fractures: late results after fixation of the posterior fragment. Orthopedics 12:1053-1059, 1989Heim UF. Trimalleolar fractures: late results after fixation of the posterior fragment. Orthopedics 12:1053-1059, 1989Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma 29:1565-1570, 1989Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma 29:1565-1570, 1989Macko VW, Matthews LS, Zwirkoski P, Goldstein SA. The joint contact area of the ankle: the contribution of the posterior malleolus. J Bone Joint Surg 73:347-351, 1991Macko VW, Matthews LS, Zwirkoski P, Goldstein SA. The joint contact area of the ankle: the contribution of the posterior malleolus. J Bone Joint Surg 73:347-351, 1991McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle: an end result study. Clin Orthop Relat Res 122:37-45, 1977McDaniel WJ, Wilson FC. Trimalleolar fractures of the ankle: an end result study. Clin Orthop Relat Res 122:37-45, 1977Meyer TL Jr, Kumler KW. A.S.I.F. technique and ankle fractures. Clin Orthop Relat Res 150:211-216, 1980Meyer TL Jr, Kumler KW. A.S.I.F. technique and ankle fractures. Clin Orthop Relat Res 150:211-216, 1980Stormont DM, Morrey BF, An KN, Cass JR. Stability of the load- ed ankle. Relation between articular restraint and primary and secondary static restraints. Am J Sports Med 13:295-300, 1985Stormont DM, Morrey BF, An KN, Cass JR. Stability of the load- ed ankle. Relation between articular restraint and primary and secondary static restraints. Am J Sports Med 13:295-300, 1985Gardner MJ, Brodsky A, Briggs SM, Nielson JH, Lorich DG. Fixation of posterior malleolar fractures provides greater syndesmotic sta- bility. Clin Orthop Relat Res 447:165-171, 2006Gardner MJ, Brodsky A, Briggs SM, Nielson JH, Lorich DG. Fixation of posterior malleolar fractures provides greater syndesmotic sta- bility. Clin Orthop Relat Res 447:165-171, 2006Lauge Hansen N, Ankelbrurd L. Genetisk diagnose og reposi- tion. Copenhagen Munkdsgaard, 1942Lauge Hansen N, Ankelbrurd L. Genetisk diagnose og reposi- tion. Copenhagen Munkdsgaard, 1942Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome: prev- alence and analysis of 639 acute injuries. J Foot Ankle Surg 37:280- 285, 1998Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome: prev- alence and analysis of 639 acute injuries. J Foot Ankle Surg 37:280- 285, 1998Beumer A, Valstar ER, Garling EH, Niesing R, Ginai AZ, Rans- tam J, Swierstra BA. Effects of ligament sectioning on the kinematics of the distal tibiofibular syndesmosis: a radiostereometric study of 10 cadaveric specimens based on presumed trauma mechanisms with suggestions for treatment. Acta Orthop 773:531-540, 2006Beumer A, Valstar ER, Garling EH, Niesing R, Ginai AZ, Rans- tam J, Swierstra BA. Effects of ligament sectioning on the kinematics of the distal tibiofibular syndesmosis: a radiostereometric study of 10 cadaveric specimens based on presumed trauma mechanisms with suggestions for treatment. Acta Orthop 773:531-540, 2006

The authors declare that there are no conflicts of interest present.