TibiofibularSyndesmose

TibiofibularSyndesmose is the fibrous joint complex between the distal tibia and fibula that stabilizes the ankle mortise. It is made up of the distal tibiofibular joint and its supporting ligaments: the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament, the interosseous tibiofibular ligament, and the transverse ligament. Together with the distal interosseous membrane, these structures bind the two bones at the ankle and help maintain the integrity of the ankle syndesmosis.

The syndesmosis provides static stability to the ankle mortise and contributes to load transfer from the foot to the leg during weight bearing. The ligaments allow a small amount of motion to accommodate ankle movements while preventing excessive separation of the tibia and fibula. Proper alignment of the distal tibiofibular joint is essential for a stable talar articulation within the ankle joint.

Injuries to the tibiofibularSyndesmose are most commonly seen as high ankle sprains, typically resulting from external rotation of the foot and/or forced dorsiflexion. Such injuries can occur with or without associated fibular fracture and may present with pain above the ankle joint, tenderness over the syndesmosis, and pain with dorsiflexion or external rotation. Radiographs can show a widened tibiofibular clear space or disrupted mortise alignment; MRI or CT can confirm ligament injury.

Management depends on stability. Stable injuries may be treated nonoperatively with immobilization and rehabilitation. Unstable injuries or diastasis often require surgical fixation across the syndesmosis, using screws or suture-button devices, with subsequent rehabilitation and possible hardware removal. Prognosis varies with injury severity and timeliness of treatment.