Diagnosis and Management of Pediatric Syndesmosis Ankle Injuries

» Pediatric syndesmotic ankle injuries are uncommon but increasingly recognized, particularly among youth athletes participating in pivoting and contact sports such as football, soccer, and skiing.» The most sensitive and specific modalities for diagnosis are advanced imaging techniques such as magnetic resonance imaging and computed tomography; standard radiographic parameters (tibiofibular overlap, medial clear space) are less reliable in children.» An evidence-based approach to management distinguishes stable injuries, amenable to nonoperative care with immobilization and rehabilitation, from unstable injuries that may require surgical fixation.» Surgical techniques-including syndesmotic screw and suture-button fixation-must account for skeletally immature anatomy; the decision to remove hardware is controversial.» There is a substantial gap in pediatric-specific literature regarding standard radiographic imaging parameters, optimal fixation methods, and long-term outcomes, highlighting the need for further prospective studies in skeletally immature athletes.