Magan Ahmed, Golano Pau, Maffulli Nicola, Khanduja Vikas
Addenbrooke's Cambridge University Hospitals NHS Trust, Cambridge, UK.
Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.
Br Med Bull. 2014 Sep;111(1):101-15. doi: 10.1093/bmb/ldu020.
Injury to the tibiofibular syndesmosis often arises from external rotation force acting on the foot leading to eversion of the talus within the ankle mortise and increased dorsiflexion or plantar flexion. Such injuries can present in the absence of a fracture. Therefore, diagnosis of these injuries can be challenging, and often stress radiographs are helpful. Magnetic resonance imaging scans can be a useful adjunct in doubtful cases. The management of syndesmotic injuries remains controversial, and there is no consensus on how to optimally fix syndesmosis. This article reviews the mechanism of injury, clinical features and investigations performed for syndesmotic injuries and brings the reader up-to-date with the current evidence in terms of the controversies surrounding the management of these injuries.
Embase, Pubmed Medline, Cochrane Library, Elsevier and Google Scholar (January 1950-2014).
The management of syndesmotic injuries remains controversial, and there is no consensus on: (i) which ankle fractures require syndesmotic fixation, (ii) the number or the size and the type of screws that should be used for fixation, (iii) how many cortices to engage for fixation, (iv) the level of screw placement above the ankle plafond, (v) the duration for which the screw needs to remain in situ to allow the tibiofibular syndesmosis to heal and (vi) when should patients weight bear.
(i) A high proportion of syndesmotic fixations demonstrates malreduction of the syndesmosis, (ii) no need to remove screws routinely, (iii) two screws appear to better one alone and (iv) if syndesmosis injury is not detected or not treated long term, it leads to pain and arthritis.
(i) How to assess the adequacy of syndesmotic reduction using imaging in the peri-operative period, (ii) the use of bio-absorbable materials and Tightrope and (iii) evidence is emerging not to remove syndesmotic screws unless symptomatic.
(i) A bio-absorbable material that can be used to fix the syndesmosis and allow early weight bearing, and (ii) there is a need for developing a surgical technique for adequately reducing the syndesmosis without the exposure to radiation.
胫腓联合损伤通常源于作用于足部的外旋力，导致距骨在踝关节 mortise 内外翻以及背屈或跖屈增加。此类损伤可能在无骨折的情况下出现。因此，这些损伤的诊断可能具有挑战性，应力位 X 光片通常很有帮助。磁共振成像扫描在可疑病例中可能是一种有用的辅助手段。胫腓联合损伤的治疗仍存在争议，对于如何最佳固定胫腓联合尚无共识。本文回顾了胫腓联合损伤的损伤机制、临床特征和所进行的检查，并使读者了解围绕这些损伤治疗争议的当前证据。
Embase、Pubmed Medline、Cochrane 图书馆、爱思唯尔和谷歌学术（1950 年 1 月至 2014 年）。
胫腓联合损伤的治疗仍存在争议，在以下方面尚无共识：（i）哪些踝关节骨折需要胫腓联合固定；（ii）用于固定的螺钉数量、尺寸和类型；（iii）固定时应穿透多少皮质骨；（iv）螺钉在踝关节面上方的放置水平；（v）螺钉需要原位保留多长时间以使胫腓联合愈合；（vi）患者何时应负重。
（i）很大一部分胫腓联合固定显示胫腓联合复位不良；（ii）无需常规取出螺钉；（iii）两枚螺钉似乎比一枚更好；（iv）如果未检测到或未长期治疗胫腓联合损伤，会导致疼痛和关节炎。
（i）如何在围手术期使用影像学评估胫腓联合复位的充分性；（ii）生物可吸收材料和 Tightrope 的使用；（iii）越来越多的证据表明，除非有症状，否则不应取出胫腓联合螺钉。
（i）一种可用于固定胫腓联合并允许早期负重的生物可吸收材料；（ii）需要开发一种在不暴露于辐射的情况下充分复位胫腓联合的手术技术。
