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Fibrous joints are a type of joint where the bones are connected by fibrous connective tissue. These joints provide stability and minimal to no movement between the articulating bones. There are three types of fibrous joints.
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All the bones of the skull, except for the mandible, are joined to each other by a fibrous joint called a suture. The fibrous connective tissue found at a suture strongly unites the adjacent skull bones and thus helps to protect the brain and form the face. In...
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Syndesmosis Stabilisation: Screws Versus Flexible Fixation.

Matthew C Solan1, Mark S Davies2, Anthony Sakellariou3

  • 1London Foot and Ankle Centre, Hospital of St John and St Elizabeth, 60 Grove End Road, London NW8 9NH, UK; Surrey Foot and Ankle Clinic, Mount Alvernia Hospital, Harvey Road, Guildford, Surrey, GU1 3LX, UK.

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Summary

Ankle syndesmosis injury management is debated. Proper assessment of ankle instability is key to determining if syndesmosis stabilization is needed, especially with fibula or posterior malleolus fractures.

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AnkleInjurySyndesmosisTightRope

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Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Sports Medicine

Background:

  • Ankle syndesmosis injuries present management controversies in orthopedic surgery.
  • Current practices for treating these injuries vary widely with unanswered questions.
  • Accurate assessment of ankle instability is crucial for effective treatment.

Purpose of the Study:

  • To review the indications and techniques for stabilizing the distal tibiofibular joint.
  • To clarify when syndesmosis stabilization is necessary versus when it can be omitted.
  • To provide clinical examples illustrating management strategies.

Main Methods:

  • Review of current literature on ankle syndesmosis injuries.
  • Analysis of fracture patterns affecting ankle stability (fibula shaft, posterior malleolus).
  • Discussion of diagnostic criteria for assessing syndesmotic instability.

Main Results:

  • Fixation of associated fibula shaft or posterior malleolus fractures can provide sufficient stability, potentially obviating the need for direct syndesmosis stabilization.
  • The extent of ankle instability dictates the necessity and approach to syndesmosis stabilization.
  • Restoring the integrity of the ankle mortise is the primary goal.

Conclusions:

  • The decision to stabilize the ankle syndesmosis should be based on a thorough evaluation of ankle joint stability.
  • In certain fractures (e.g., fibula shaft, posterior malleolus), surgical fixation may inherently stabilize the syndesmosis.
  • A tailored approach considering fracture patterns and instability is essential for optimal outcomes in ankle syndesmosis injuries.