[Chronic ankle joint instability: in unrecognized distal rupture of the syndosmosis and malunion of the distal fibula].

BACKGROUND

It is often difficult in the acute phase to diagnose a lesion of the distal tibiofibular syndesmosis. If this lesion is overlooked, the patient will develop an incongruity of the upper ankle joint with a pathological external rotation of the talus. The risk of a possible premature arthritis is clearly increased.

OBJECTIVES

In this case study a distal rupture of the syndesmosis in a young patient was overlooked in the initial diagnostic work-up.

METHODS

A search of the relevant literature and a case report.

RESULTS

In the case described the shortened fibula and chronic instability of the tibiofibular syndesmosis were repaired with a lengthening and derotational osteotomy and reconstruction using the gracilis muscle tendon. Through this method an exact reconstruction of the normal anatomy could be achieved.

CONCLUSION

Posttraumatic misalignment in the ankle joint is associated with a high risk of secondary degenerative lesions. In cases with suspicion of a syndesmosis lesion, confirmation of the diagnosis is imperative so as to perform an anatomic repositioning and reconstruction of stability.