Arthrodesis of the Distal Tibiofibular Joint: A Review of the Literature and Evidence-based Guidelines

Distal tibiofibular joint (DTFJ) arthrodesis has been proposed as a motion-preserving salvage option in cases of chronic syndesmotic disruption and degeneration. It is an uncommonly performed procedure with few cases reported in the literature. The aim of this study was to conduct a review of the literature in order to examine the appropriate indications, operative techniques, and outcomes. The authors’ also present a case for inclusion. Twenty cases of DTFJ arthrodesis were identified for inclusion. Nine operations were performed in males and 11 in females. The average patient age was 41.1 years. The indication for all arthrodeses was chronic pain±instability. Symptoms were a result of disruption of the DTFJ secondary to: (a) previous fracture malunion (n=12), (b) soft tissue injury (n=6), or (c) osteochondroma (n=2). DTFJ arthrodesis has been successfully utilized in cases of syndesmosis disruption secondary to osteochondroma, fracture and soft tissue injury in low-demand and high-demand adult patients of any age and activity level. Arthrodesis can be performed through an anterior or lateral ankle approach. Fixation with 2×3.5 mm screws across the DTFJ impacted with autologous bone graft provides sufficient fixation. Patient should nonweight bear on an immobilized ankle for a minimum of 6 weeks, or until bony union is evident on imaging. Level of Evidence: Diagnostic Level IV.