Syndesmosis procedure

Painful hallux valgus

Syndesmosis procedure refers to a surgical intervention aimed at repairing or stabilizing a syndesmosis joint, which is a type of fibrous joint where bones are joined together by connective tissue. This procedure is most commonly associated with the ankle, where it addresses injuries to the syndesmosis ligament, also known as the distal tibiofibular syndesmosis. Such injuries are often the result of high ankle sprains or fractures that affect the stability between the tibia and fibula.

Indications

The primary indication for a syndesmosis procedure is an injury that leads to instability or widening of the syndesmosis joint. This can occur due to traumatic events such as ankle fractures, severe ankle sprains, or other mechanisms that cause excessive force on the syndesmosis. Symptoms of a syndesmotic injury include pain, especially with weight-bearing, swelling, and a sense of instability in the ankle.

Procedure

The syndesmosis procedure can be performed using various surgical techniques, depending on the severity and nature of the injury. The most common methods include:

• Syndesmotic Screw Fixation: This involves the insertion of one or more screws across the syndesmosis to hold the tibia and fibula together, allowing the ligaments to heal in the correct position. The screws may be removed after healing, depending on the case.

• Suture Button Fixation: An alternative to screw fixation, this technique uses a flexible suture button device to stabilize the syndesmosis. It allows for some degree of physiological motion at the joint, potentially reducing the need for hardware removal.

• Direct Repair of Ligaments: In cases where the ligaments are damaged, direct repair may be performed. This can involve stitching the ligaments back together or using grafts to reconstruct the damaged areas.

Recovery

Recovery from a syndesmosis procedure varies based on the surgical technique used and the severity of the injury. Generally, patients can expect a period of non-weight bearing or limited weight bearing on the affected leg. Physical therapy is an essential component of recovery, focusing on restoring range of motion, strength, and stability to the ankle.

Complications

As with any surgical procedure, there are potential complications associated with syndesmosis procedures. These can include infection, nerve damage, hardware failure, and the possibility of developing arthritis in the joint. Additionally, there is a risk that the syndesmosis may not heal in the correct position, leading to chronic instability or pain.

Conclusion

The syndesmosis procedure is a critical intervention for addressing significant injuries to the syndesmosis joint, particularly in the ankle. With appropriate surgical management and rehabilitation, most patients can expect to return to their previous levels of activity. However, the complexity of the syndesmosis and its importance in ankle stability necessitate careful consideration in both the surgical and recovery processes.