Syndesmotic Injuries: Is There a New Standard of Care? A Case Report and Commentary

D iagnosis and treatment of syndesmotic injuries, whether associated with malleolar ankle fractures, Maisonneuve fractures or purely ligamentous injuries, has been extensively researched. There has been increasing interest as more recent studies have demonstrated a relatively high rate of syndesmotic malreduction and resultant morbidity after surgical fixation. These studies suggest the need for more advanced imaging studies both preoperatively and intraoperatively, as well as a change in traditionally used surgical techniques, to ensure optimal treatment of syndesmotic injuries. Obtaining plain radiographs of the injured ankle followed by fixation of the syndesmosis using classically taught reduction techniques with intraoperative fluoroscopy to ensure proper reduction has long been the standard of care. However, the current evidence suggests that doing things the old way may be the wrong way. We present an illustrative case report as well as a commentary based on the current literature.