Imaging Features and Missed Diagnosis Causes of Malreduction of Distal Tibiofibular Syndesmosis

ZHANG Yi; JIN Yu; ZHANG Qing-zhu; ZHOU Wei-na; CAO Xiang-yu; SHI Li-tao; ZHAI Dong

doi:10.3969/j.issn.1002-3429.2017.06.016

Abstract：Objective To summarize imaging features of patients with malreduction of distal tibiofibular syndesmosis and to analyze missed diagnosis causes.Methods Clinical data of 23 patients with malreduction of distal tibiofibular syndesmosis after surgery for ankle fractures combined with distal tibiofibular syndesmosis injury during January 2013 and December was retrospectively analyzed.Results The malreduction rate of distal tibiofibular syndesmosis was 47.9%.All patients were confirmed the diagnosis by ankle CT scanning and X-ray.There are 9 patients with simple interspace widening in distal fibula, 4 patients with ante/retro-displacement in fibula;3 patients with interspace widening and ante/retro-displacement in fibula;3 patients with simple antedisplacement in fibula, 2 patients with external rotation in fibula, 1 patient with simple interspace narrowing and antedisplacement in fibula and 1 patient with adtorsion conclination in fibula.The secondary surgery was performed, and 22 patients underwent plaster immobilization.With postoperative 6-28 months follow-up, no patients had skin complication or deep infection, and fractures all healed well without bone nonunion.There were 2 patients with excellent, 14 patients with good and 6 patients with common by postoperative ankle-hindfoot score, and the fineness rate was 70%.Conclusion Clinicians should highly suspect the possibility of malreduction of distal tibiofibular syndesmosis for patients with ankle fractures combined with distal tibiofibular syndesmosis injury, and related examinations should be performed as early as possible to judge index changes of related ankle joint and to avoid missed diagnosis.