Mansur Henrique, Danilo da Silva Sandro, Maranho Daniel Augusto
Department of Orthopaedics Surgery, Hospital Regional Do Gama, Brasilia, Distrito Federal, Brazil.
Department of Orthopaedics Surgery, Hospital Sírio-Libanês, Brasilia, Distrito Federal, Brazil.
J Clin Orthop Trauma. 2020 Sep 17;14:80-84. doi: 10.1016/j.jcot.2020.09.013. eCollection 2021 Mar.
Distal tibiofibular syndesmosis is a complex anatomical structure that is essential for the stability and function of the ankle. Ankle fractures are a common source of chronic syndesmosis instability with associated functional impairments and early development of osteoarthritis. Case presentation: we described a case of a 28-year-old patient who presented with symptomatic ankle subluxation and chronic syndesmosis instability. Eight months earlier, the patient sustained a minimally displaced ankle fracture that had been treated conservatively elsewhere. The surgical approach included the anatomical realignment of the distal fibula with a lengthening derotational osteotomy and tibiofibular syndesmosis reconstruction using an autologous semitendinosus tendon graft. One year after surgery, the ankle function was restored, and the patient was asymptomatic. Conclusion: The instability of ankle fractures should be carefully evaluated during the treatment decision-making. Surgical treatment of syndesmosis instability should be performed even in chronic cases to restore function. The reconstruction of syndesmosis with semitendinous tendon graft associated with fibular length and realignment improves the ankle stability and function.
胫腓下联合是一个复杂的解剖结构，对踝关节的稳定性和功能至关重要。踝关节骨折是慢性下联合不稳定的常见原因，伴有功能障碍和骨关节炎的早期发展。病例报告：我们描述了一例28岁患者，表现为有症状的踝关节半脱位和慢性下联合不稳定。八个月前，该患者发生了一处移位轻微的踝关节骨折，在其他地方接受了保守治疗。手术方法包括通过延长旋转截骨术对腓骨远端进行解剖复位，以及使用自体半腱肌腱移植重建胫腓下联合。术后一年，踝关节功能恢复，患者无症状。结论：在治疗决策过程中应仔细评估踝关节骨折的不稳定性。即使在慢性病例中，也应进行下联合不稳定的手术治疗以恢复功能。用半腱肌腱移植重建下联合并结合腓骨长度调整和复位可改善踝关节的稳定性和功能。
