Surgical Treatment of Distal Tibiofibular Syndesmosis Injuries Using Open Reduction Internal Fixation by Plate and Screws: A Case Series and Literature Review

Treatment of distal tibiofibular syndesmosis injuries requires an early and accurate reduction to prevent poor outcomes. Screw fixation technique remains the gold standard for syndesmosis injuries despite the increasing popularity of suture button fixation. We report the cases of three patients with acute distal tibiofibular syndesmosis injuries treated by open reduction and internal fixation using a plate and two screws. The objective of this study was to describe a different syndesmosis fixation technique with a two holes one-third tubular plate and two screws, relate the radiologic findings and analyze the functional outcomes. Clinical and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. Reduction of the syndesmosis was assessed radiographically by measuring the tibiofibular clear space, tibiofibular overlap, and the medial clear space at the final follow-up. Compared to preoperative values, postoperative values were improved with this method. Our findings suggest this new technique as a safe and reliable option to consider for the treatment of acute distal tibiofibular syndesmosis injuries. The main advantage is an optimal positioning of the screws on the lateral fibular cortex in the anteroposterior plan with an ideal space between them.