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Probably one of the most controversial subjects in the orthopedic field is the distal tibiofibular articulation. Even though its most primary knowledge can be a matter of enormous debate, it is in the diagnosis and treatment most of the disagreements reign. Distinguishing between injury and instability remains challenging as well as an optimal clinical decision regarding surgical intervention. The last years presented technology and that was able to bring body to an already well-developed scientifical rationale. In this review article, we aim to demonstrate the current data behind syndesmotic instability in the ligament scenario, whereas using few fracture concepts.
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http://dx.doi.org/10.1016/j.fcl.2023.01.006 | DOI Listing |
Orthop Traumatol Surg Res
August 2025
Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France.
Background: Bimalleolar equivalent fractures (BEF) represent a particularly challenging subset of ankle fractures, with ongoing debate among ankle surgeons about the necessity of systematic deltoid ligament repair. The present study aims to address this controversy by investigating the radiological and clinical outcomes of deltoid ligament repair in BEF compared to conservative management.
Hypothesis: Systematic deltoid ligament repair in BEF is not necessary.
Am J Sports Med
September 2025
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, (MUM), University Hospital, LMU Munich, Munich, Bavaria, Germany.
Background: Despite studies on syndesmotic and deltoid ligament (DL) repair, the biomechanical role of (partial or full) ligament repair and bracing in unstable ankles to regain rotational stability remains unclear.
Purpose: To determine the ability of surgical intervention on syndesmosis and SLs with suture repair and ligament bracing to restore intact external rotation ankle stability.
Study Design: Controlled laboratory study.
Am J Sports Med
September 2025
Orthopedic Foot and Ankle Department, DrNasef OrthoClinic, Cairo, Egypt.
Background: The syndesmotic and deltoid ligament (DL) complex contributes to ankle stability. However, the biomechanical role of (partial or complete) ligamentous injuries on external rotation instability remains unclear.
Purpose: To determine the contribution of syndesmosis and DL injuries to external rotation instability compared with the intact ankle.
Sci Rep
August 2025
Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Germany.
Identifying syndesmotic instability in ankle fractures using conventional radiographs is still a major challenge. In this study we trained a convolutional neural network (CNN) to classify the fracture utilizing the AO-classification (AO-44 A/B/C) and to simultaneously detect syndesmosis instability in the conventional radiograph by leveraging the intraoperative stress testing as the gold standard. In this retrospective exploratory study we identified 700 patients with rotational ankle fractures at a university hospital from 2019 to 2024, from whom 1588 digital radiographs were extracted to train, validate, and test a CNN.
View Article and Find Full Text PDFJ Orthop Case Rep
August 2025
Department of Orthopaedic Surgery, Cantonal Hospital of Fribourg, Fribourg, Switzerland.
Introduction: Syndesmotic injuries, particularly those involving the posterior inferior tibiofibular ligament (PITFL), are complex and often result in chronic pain and instability if not appropriately treated. The PITFL plays a crucial role in maintaining syndesmotic stability, especially in resisting rotational forces. This case report examines a PITFL injury involving two posterior fibular fragments, supporting the hypothesis that the superficial and deep components of the ligament function independently.
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