Is It Possible to Overcompress the Syndesmosis?

Published:March 13, 2018DOI:


      The case we present suggests that it might be possible to overcompress the syndesmosis, causing subluxation of the talus within the ankle mortise. A 26-year-old female patient had had a Weber Type C ankle fracture internally fixed with a lateral plate and syndesmosis screws. Despite the fibula appearing well reduced and computed tomography imaging showing a well-aligned fibula within the fibular notch, anteromedial subluxation of the talus was present in the ankle mortise. Examination with the patient under anesthesia revealed a stable syndesmosis fixation; however, talar malpositioning was not affected by the foot position. The syndesmosis fixation was revised sequentially. As the fixation was relaxed sequentially, the talus appeared to reduce within the ankle mortise, with restoration of the previously obliterated medial clear space. The syndesmosis was stabilized with a single 3.5-mm cortical screw in a reduced position. The patient had made a full recovery at the 12-month follow-up examination, having undergone elective syndesmosis screw removal at 12 weeks postoperatively. Several studies have suggested that it might not be possible to overcompress the syndesmosis and have even advocated the use of a lag screw technique for syndesmosis fixation. Based on the present case, we would advise a degree of caution with this approach, because it might be possible to overcompress the syndesmosis and cause significant subluxation of the tibiotalar articulation.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment


        • Elsoe R.
        • Ostgaard S.E.
        • Larsen P.
        Population-based epidemiology of 9767 ankle fractures.
        Foot Ankle Surg. 2018; 24: 34-39
        • Court-Brown C.M.
        • Caesar B.
        Epidemiology of adult fractures: a review.
        Injury. 2006; 37: 691-697
        • Naqvi G.A.
        • Cunningham P.
        • Lynch B.
        • Galvin R.
        • Awan N.
        Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction.
        Am J Sports Med. 2012; 40: 2828-2835
        • Singh R.
        • Kamal T.
        • Roulohamin N.
        • Maoharan G.
        • Ahmed B.
        • Theobald P.
        Ankle fractures: a literature review of current treatment methods.
        Open J Orthop. 2014; 4: 292-303
        • Marmor M.
        • Hansen E.
        • Han H.K.
        • Buckley J.
        • Matityahu A.
        Limitations of standard fluoroscopy in detecting rotational malreduction of the syndesmosis in an ankle fracture model.
        Foot Ankle Int. 2011; 32: 616-622
        • Tornetta P.
        • Spoo J.E.
        • Reynolds F.A.
        • Lee C.
        Overtightening of the ankle syndesmosis: is it really possible?.
        J Bone Joint Surg Am. 2001; 83-A: 489-492
        • Gonzalez T.
        • Egan J.
        • Ghorbanhoseini M.
        • Blais M.
        • Lechtig A.
        • Velasco B.
        • Nazarian A.
        • Kwon J.Y.
        Overtightening of the syndesmosis revisited and the effect of syndesmotic malreduction on ankle dorsiflexion.
        Injury. 2017; 48: 1253-1257
        • Kwaadu K.Y.
        • Fleming J.J.
        • Salmon T.
        Lagged syndesmotic fixation: our clinical experience.
        J Foot Ankle Surg. 2015; 54: 773-781
        • Phisitkul P.
        • Ebinger T.
        • Goetz J.
        • Vaseenon T.
        • Marsh J.L.
        Forceps reduction of the syndesmosis in rotational ankle fractures: a cadaveric study.
        J Bone Joint Surg Am. 2012; 94: 2256-2261
        • Cherney S.M.
        • Haynes H.A.
        • Spraggs-Hughes A.
        • McAndrew C.M.
        • Ricci W.M.
        • Gardner M.J.
        In vivo syndesmotic over-compression after fixation of ankle fractures with a syndesmotic injury.
        J Orthop Trauma. 2015; 29: 414-419
        • Odak S.
        • Ahluwali R.
        • Unnikrishan P.
        • Hennessy M.
        • Platt S.
        Management of posterior malleolar fractures: a systematic review.
        J Foot Ankle Surg. 2016; 55: 140-145