High Ankle (Syndesmosis) Sprain

• High Ankle/ Syndesmosis Sprain:

  • Injury to inferior tibiofibular joint
  • Mechanism of injury (MOI):
  • External Rotation + forced dorsiflexion
• High Ankle/ Syndesmosis Sprain - Other differentials:

  • Bony injury (malleolus/tibia)
  • Superficial Peroneal Nerve
  • Don’t miss Maisonneuve fracture (spiral fracture of fibula leads to fracture at proximal fibula/knee)
• Signs and symptoms:

  • Pain proximal to ankle joint
  • Pain on forced Dorsiflexion and external rotation
  • Prolonged disability
  • Confirmed by weightbearing X-ray (mortise view) - gapping between talus and tibia indicates disruption of inferior tibiofibular ligament and syndesmosis

  
• Management:

  • Aircast boot ASAP (for 2 - 6 weeks)
  • Many need surgery