Tibiofibular Diastasis

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Clinically Relevant Anatomy

Tibiofibular syndesmoses include a anterior and posterior inferior tibiofibular ligaments and the transverse ligament and membrane interrosseus. It connects the distal fibula, tibia and talus.

Mechanism of Injury / Pathological Process

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Clinical Presentation

Tibiofibular diastasis is often associated with extensive ligamentous tears and often with external rotation or abduction injuries to the ankle. This condition may occur without associated fracture, but may also occur with fracture where there is rupture of the internal malleolus or rupture of the internal lateral ligament. There is also a fracture of the posterior part of the tibia extending into the joint.

Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

Tibiofibular diastasis without fracture can be classified into 4 types;
o Type1 :
Type I injuries demonstrate straight lateral fibular subluxation without plastic deformation of the fibula and are best treated by open reduction, removing any intervening soft tissue, and stabilization with a tibiofibular screw.
o Type2:
Type II injuries are injuries with straight lateral subluxation of the fibula due to plastic deformation of the distal fibula. Fibular osteotomy can be used for reduction, before the internal fixation.
o Type 3:
Type III injuries consist of posterior rotation subluxation of the fibula. The talus superiorly will be disrupted, resulting in divergence of the tibia and fibula.
o Type 4:
The talus is dislocated superiorly causing a wedge effect between the tibia and fibula resulting in an increase of the intermalleolar distance.
Type III and IV injuries can usually be treated by closed manipulation and plaster immobilization.

Key Evidence

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Resources

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References

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