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Ankle Syndesmosis Injuries
The ankle syndesmosis is composed of the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament, the inferior transverse tibiofibular ligament, and the interosseous ligament. Disruption of the syndesmotic complex leads to abnormal mechanics of the ankle mortise, including lateral translation of the fibula and external rotation of the talus; the resultant weight-bearing forces are borne only by the tibiotalar articulation. Syndesmotic injuries can occur in isolation as the result of an eversion ankle injury (high ankle sprain) or in the setting of acute ankle fractures. Stabilizing the syndesmosis in the acute setting takes advantage of the healing process after the acute injury to restore ligamentous stability. Fixation alone in the chronic setting will not adequately restore syndesmotic stability; thus, alternative treatments should be considered. This chapter reviews the indications, contraindications, and surgical procedure steps for acute and chronic syndesmotic fixation and reconstruction.