Orthopedics Book


High Ankle Sprain

Aka: High Ankle Sprain, Syndesmotic Sprain, Syndesmosis Sprain, Syndesmotic Injury, Sprain of Distal Tibiofibular Ligament, Distal Tibiofibular Sprain
  1. See Also
    1. Ankle Sprain
    2. Ankle Sprain Management
  2. Epidemiology
    1. Accounts for up to 10% of Ankle Sprains in high risk populations
    2. Most common sports associated with High Ankle Sprain
      1. Football
      2. Downhill Skiing
  3. Mechanism
    1. Eversion and Rotation injury
    2. Hyper-dorsiflexion
  4. Anatomy
    1. Tibiofibular Syndesmosis injury
      1. Interosseous membrane (IM)
      2. Anterior Inferior tibiofibular ligament (AITF)
    2. Separation of Tibia from fibula
  5. Symptoms
    1. Medial ankle pain
    2. Difficulty bearing weight
  6. Signs
    1. Minimal external signs of injury (e.g. swelling)
    2. Pain and Disability out of proportion with injury
    3. Ankle may feel spongy
    4. Ankle Squeeze Test positive
    5. Ankle External Rotation Test positive
    6. Crossed-Leg Test positive
    7. Point tenderness over anterior and proximal ankle
      1. Pain at distal tibiofibular joint
  7. Associated conditions
    1. Maisonneuve Fracture
      1. Proximal Fibula Fracture
      2. Palpate full length of fibula and tibia on exam
  8. Imaging
    1. Ankle XRay
      1. Tibiofibular clear space widening >6 mm indicates complete syndesmotic rupture
    2. Tibia-Fibula XRay
      1. Exclude Proximal Fibula Fracture (Maisonneuve Injury)
    3. Ankle MRI
      1. Persistent Disability in an injury suggestive of High Ankle Sprain
  9. Management
    1. No early mobilization
    2. May require internal fixation
  10. Prognosis
    1. More disabling than other Ankle Sprains
      1. May require 4-5 months to return to prior functional capacity
    2. Risk of ankle Degenerative Joint Disease
  11. References
    1. Molinari (2009) Iowa Orthop J 29:130-8 [PubMed]
    2. Rifat (1996) Am Fam Physician 53(8):2491-8 [PubMed]
    3. Rubin (1996) Am Fam Physician 54(5):1609-18 [PubMed]
    4. Sitler (1995) Sports Med 20(1):53-7 [PubMed]
    5. Swain (1993) Postgrad Med 90(3):91-100 [PubMed]
    6. Wolfe (2001) Am Fam Physician 63(1):93-104 [PubMed]

Sprain of distal tibiofibular ligament (C0160091)

Concepts Injury or Poisoning (T037)
ICD9 845.03
SnomedCT 74383007
English Tibiofibular (ligament) sprain, distal, Sprain distal tibiofibul, Sprain of tibiofibular (ligament), distal of ankle, Sprain of distal tibiofibular ligament, Sprain of distal tibiofibular ligament (disorder), Tibiofibular ligament sprain, distal
Dutch tibiofibulaire (ligament)verstuiking, distaal
French Entorse du ligament tibio-péronier distal
German tibiofibulare (Band) Verstauchung, distal
Italian Distorsione del (legamento) tibiofibulare distale
Portuguese Estiramento do ligamento tibioperonial distal
Spanish Esguince (ligamentoso) tibioperoneo distal, esguince del ligamento tibioperóneo distal (trastorno), esguince del ligamento tibioperóneo distal, estrema del ligamento tibioperóneo distal
Japanese 遠位脛腓(靱帯)捻挫, エンイケイヒジンタイネンザ
Czech Podvrtnutí distálního tibiofibulárního vazu
Hungarian Tibiofibularis (szalag) húzódás, distalis
Derived from the NIH UMLS (Unified Medical Language System)

Distal tibiofibular sprain (C0434455)

Concepts Injury or Poisoning (T037)
SnomedCT 209533005
English Distal tibiofibular sprain, Distal tibiofibular sprain (disorder), Tibiofibular sprain, distal
Spanish esguince tibioperoneo distal (trastorno), esguince tibioperoneo distal
Derived from the NIH UMLS (Unified Medical Language System)

Syndesmotic Injuries (C3661498)

Concepts Injury or Poisoning (T037)
MSH D016512
English Syndesmotic Injury, Syndesmotic Injuries, Injury, Syndesmotic, Injuries, Syndesmotic
Derived from the NIH UMLS (Unified Medical Language System)

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