Normal Anatomy

Its best to think in the axial plane when treating these injuries.

 

The fibula is located in the incisural notch of the tibia.

 

Strong anterior, posterior and interosseous ligaments hold the fibula in position, whilst allowing dynamic movement through the gait cycle.

 

Reduction should reverse the mechanism of injury, allowing the fibula to fit snugly within the incisural notch. (Tornetta 2001).

 

 

Normal Physiology

The fibula has a dynamic relationship with the tibia.

 

During the gait cycle, the fibula can move up to 3mm and externally rotate up to 5 degrees. (Beumer 2003).

 

Patients with rigid fixation of the syndesmosis following screw fixation subjectively have a statistically worse ankle scores - ironically, those with broken, loosened or removed screws have significantly better functional outcome, but have the downside of causing a wider tibiofibular late diastasis (Manjoo 2007).