• Andrzej Boszczyk, Sławomir Kwapisz, Martin Krümmel, Rene Grass, and Stefan Rammelt.
• 1 Centre of Postgraduate Medical Education, Prof. Adam Gruca Clinical Hospital, Otwock, Poland.
• Foot Ankle Int. 2018 Mar 1; 39 (3): 369-375.

BackgroundThe anatomy of the syndesmosis is variable, yet little is known on the correlation between differences in anatomy and syndesmosis reduction results. The aim of this study was to analyze the correlation between syndesmotic anatomy and the modes of syndesmotic malreduction.MethodsBilateral postreduction ankle computed tomography (CT) scans of 72 patients treated for fractures with syndesmotic disruption were analyzed. Incisura depth, fibular engagement into the incisura, and incisura rotation were correlated with degree of syndesmotic malreduction in coronal and sagittal planes as well as rotational malreduction.ResultsClinically relevant malreduction in the coronal plane, sagittal plane, and rotation affected 8.3%, 27.8%, and 19.4% of syndesmoses, respectively. The syndesmoses with a deep incisura and the fibula not engaged into the tibial incisura were at risk of overcompression, anteverted incisuras at risk of anterior fibular translation, and retroverted incisuras at risk of posterior fibular translation.ConclusionsCertain morphologic configurations of the tibial incisura increased the risk of specific syndesmotic malreduction patterns.Level Of EvidenceLevel III, comparative study.

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