The distal tibiofibular syndesmosis is a fibrous joint (syndesmosis) binding the tibia and fibula above the ankle mortise, consisting of the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, interosseous ligament, and transverse tibiofibular ligament.
Maintains the mortise width that allows accurate tibiotalar congruence throughout the flexion arc, distributes load between the tibia and fibula, and resists fibular rotation and lateral displacement during ankle loading.
Syndesmotic injuries (high ankle sprains) produce a positive squeeze test and external rotation stress test, with mortise widening greater than 6mm indicating diastasis requiring screw or suture-button fixation. Missed or under-treated syndesmotic injuries produce chronic ankle pain and early post-traumatic arthritis.
Complete syndesmotic ligament complex disruption producing mortise widening, managed by accurate reduction and fixation with syndesmotic screw or elastic suture-button device for 6-8 weeks.
Partial syndesmotic injury without mortise widening producing prolonged recovery compared to lateral ankle sprain, managed by protected weight-bearing and functional rehabilitation for 6-12 weeks.
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