Syndesmosis procedure

Surgical procedure to stabilize the syndesmosis

Syndesmosis Procedure

A syndesmosis procedure is a surgical intervention aimed at stabilizing the syndesmosis, which is a fibrous joint where two bones are joined together by connective tissue. This procedure is commonly performed to address injuries or instability in the ankle or foot, particularly following trauma or in cases of chronic instability.

Before syndesmosis surgery

Anatomy of the Syndesmosis

The syndesmosis is a critical structure in the lower leg, primarily involving the tibia and fibula in the ankle. It consists of several ligaments, including the anterior and posterior tibiofibular ligaments, which help maintain the stability of the ankle joint. Disruption of these ligaments can lead to significant instability and pain.

Indications for Surgery

Syndesmosis procedures are indicated in cases of:

• Acute syndesmotic injuries, often resulting from high-energy trauma such as sports injuries or falls.
• Chronic instability due to previous injuries that have not healed properly.
• Painful conditions such as hallux valgus that may require stabilization of the first metatarsal.

Painful hallux valgus

Surgical Techniques

Several techniques can be employed in a syndesmosis procedure, including:

• Screw Fixation: This involves the insertion of one or more screws across the tibia and fibula to stabilize the joint. The screws may be removed after healing.

• Suture Button Fixation: A less invasive option that uses a suture button device to allow for some natural movement while maintaining stability.

• Cerclage Wiring: Involves the use of wires to encircle the bones and provide stabilization.

Cerclage bone sutures

• Fibrous Bridge Reconstruction: This technique uses a fibrous connecting bridge to prevent recurrence of instability.

Fibrous connecting bridge to prevent recurrence

Postoperative Care

Postoperative care is crucial for the success of a syndesmosis procedure. It typically involves:

• Immobilization of the affected limb to allow for proper healing.
• Gradual weight-bearing as tolerated, often guided by physical therapy.
• Regular follow-up to monitor healing and assess the need for hardware removal if screws were used.

Complications

Potential complications of syndesmosis procedures include:

• Infection
• Hardware irritation or failure
• Nonunion or malunion of the bones
• Persistent pain or instability

Prognosis

With appropriate surgical intervention and rehabilitation, most patients can expect a good outcome with restored stability and function of the affected joint.

Related Pages

• Ankle fracture
• Foot anatomy
• Orthopedic surgery

Normal foot skeleton

First metatarsal bone has moved aside