Опубликовать статью

Информационное партнерство

Инфоресурсы

Контакты

«

Vol. 27, Art. 12 (pp. 290-310)    |    2026       

»

Modern concepts of ankle fractures with distal tibiofibular syndesmosis rupture and methods of their treatment (Literature review).

Tsapenko V.O., Kashansky Yu.B., Kondratyev I.P., Vashetko R.V.

St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze, 192242, Saint Petersburg, Budapeshtskaya str., 3A

Brief summary

Ankle fractures represent one of the most common musculoskeletal injuries, accounting for up to 15-20% of all fractures and up to 40% of lower limb injuries. Their socioeconomic significance is determined by high incidence, prolonged disability, and substantial treatment costs. Fractures accompanied by damage to the distal tibiofibular syndesmosis (DTFS) present particular clinical challenges, as they are associated with an increased risk of chronic ankle instability, post-traumatic osteoarthritis, and unsatisfactory functional outcomes. Objective. The aim of this literature review is to systematize current data on the epidemiology, classification approaches, diagnostic algorithms, and surgical treatment methods for ankle fractures combined with distal tibiofibular syndesmosis injuries. Materials and Methods. Based on the analysis of relevant domestic and international studies (2015-2024), the advantages and disadvantages of treatment methods for ankle fractures with DTFS rupture were critically examined and analyzed in detail. Results. Current trends indicate a shift towards minimally invasive techniques for ankle fracture treatment (MIPO, intramedullary osteosynthesis), as well as an evolution in DTFS fixation methods—from static (positional screws) to dynamic (suture-button systems). Particular attention is paid to assessing the role of computed tomography (CT) in preoperative planning and intraoperative control, as well as to modern approaches to postoperative rehabilitation. Conclusions. As a result of this study, it can be concluded that optimizing care standards for this patient category requires a comprehensive, personalized approach, the integration of new diagnostic and treatment technologies into the clinical process, and further comparative analysis of data from ongoing research.


Key words

ankle fracture; distal tibiofibular syndesmosis; osteosynthesis; syndesmosis fixation; postoperative rehabilitation

Reference list

1. Pflüger P., Braun K.-F., Mair O., Kirchhoff C., Biberthaler P., Crönlein M. Current management of trimalleolar ankle fractures. EFORT Open Reviews. 2021; 6(8):692-703. doi: 10.1302/2058-5241.6.200138


2. Barabash U.A., Hrisat A.A., Grajdanov K.A., Ivanov D.V., Kayc O.A. Vibor vida chreskostnogo osteofiksatora v ysloviyah vneshnei fiksacii pri lechenii nestabilnih perelomov lodijek i ih posledstvii. Prakticheskaya medicina. 2022;20(4):13-18. doi: 10.32000/2072-1757-2022-4-13-18


3. Duan X., Kadakia A. Operative Treatment of Posterior Malleolar Fractures. Open Orthop J. 2017;11:732-742. doi: 10.2174/1874325001711010732


4. Vosseller J.T., Karl J.W., Greisberg J.K. Incidence of syndesmotic injury. Orthopedics. 2014;37(3):e226-229. doi: 10.3928/01477447-20140225-53


5. Ziegler P., Bahrs C., Konrads C., Hemmann P., Ahrend M.D. Ankle fractures of the geriatric patient: a narrative review. EFORT Open Rev. 2023;8(1):1-10. doi: 10.1530/EOR-22-0082


6. Pearce O., AL-Hourani K., Kelly M. Ankle fractures in the elderly: current concepts. Injury. 2020;51(12):2740-2747. doi: 10.1016/j.injury.2020.10.093


7. Orazliev D.A. Optimizaciya reparativnih processov pri perelomah lodijek. V kn. «IV kongress ORTOBIOLOGIYa 2023 "Patient cases - ot teorii k praktike"». Moskva; 2023:67-71.


8. Petrov N.V., Karev A.S., Celisheva E.U. Osobennosti lecheniya cherez sindesmoznih perelomov lodijek. V kn. «Novie informacionnie tehnologii v nayke MCII OMEGA SAINS». Yfa; 2016:137-139.


9. Belenkii I.G., Nikolaev I.K., Maiorov B.A., Sergeev G.D., Evseev M.N., Lyzanova O.A., Refickii U.V. Osobennosti hiryrgicheskogo lecheniya perelomov lodijek y pacientov s visokimi riskami oslojnenii (obzor literatyri). Sovremennie problemi nayki i obrazovaniya. 2023;1:85. doi: 10.17513/spno.32284


10. Ganiev M.H., Ataev A.R., Kallaev N.O., Mirzoev N.E., Osmanov R.T., Magaramov A.M., Ogyrliev A.P. Lechenie perelomov lodijek. V kn. «VIII Pirogovskii forym travmatologov-ortopedov». Kazan; 2023:141.


11. Rudi T.P., Bakli R.E., Moran K.G. AO - Principi
lecheniya perelomov. Vtoroe pererabotannoe i dopolnennoe izdanie. Vassa Media. 2007;2:870-896.


12. Martin J.S., Marsh J.L., Bonar S.K., DeCoster T.A., Found E.M., Brandser E.A. Assessment of the AO/ASIF fracture classification for the distal tibia. J Orthop Trauma. 1997;11(7):477-483. doi: 10.1097/00005131-199710000-00004


13. Harper M.C. Ankle fracture classification systems: a case for integration of the Lauge-Hansen and AO-Danis-Weber schemes. Foot Ankle J. 1992;13(7):404-407. doi: 10.1177/107110079201300708


14. Ramos L.S., Gonçalves H.M., Freitas A., Oliveira M.P., Lima D.M.S., Carmargo W.S. Evaluation of the Reproducibility of Lauge-Hansen, Danis-Weber, and AO Classifications for Ankle Fractures. Rev Bras Ortop (Sao Paulo). 2021;56(3):372-378. doi: 10.1055/s-0040-1718508


15. Belenkii I.G., Manykovskii V.A., Tylypov A.N., Demko A.E., Kandiba D.V., Sergeev G.D., Maiorov B.A., Barsykova I.M., Adjimyradov B.O. Strategiya vipolneniya osteosinteza: problemi i perspektivi. Travmatologiya i ortopediya Rossii. 2022;28(2):79-90. doi: 10.17816/2311-2905-1693


16. Jeyaseelan L., Malagelada F., Parker L., Panagopoulos A., Heidari N., Vris A. Intra-Operative 3-Dimensional Imaging (O-arm) in Foot and Ankle Trauma Surgery: Report of 2 Cases and Review of the Literature . Open Orthop J. 2019;13. doi:10.2174/1874325001913010189


17. Kovalevskii K.O., Semchin V.S., Titova A.D. Kartirovanie perelomov lodijek s ispolzovaniem 3d modelirovaniya. V kn. «X Respyblikanskoi naychno-prakticheskoi konferencii s mejdynarodnim ychastiem». Grodno; 2023:210-213.


18. Savello V.E., Belenkii I.G., Kostenikov A.N., Maiorov B.A., Refickii U.V., Sergeev G.D. Virtyalnoe planirovanie operacii osteosinteza y pacientov s perelomami lodijek i zadnego kraya bolshebercovoi kosti po rezyltatam komputernoi tomografii: klinicheskii slychai. Neotlojnaya hiryrgiya im. I.I. Djanelidze. 2024;1(14):24-33. doi: 10.54866/27129632_2024_1_24


19. Gorbatov R.O., Pavlov D.V., Malishev E.E. Sovremennoe operativnoe lechenie perelomov lodijek i ih posledstvii (obzor). Sovremennie tehnologii v medicine. 2015;7(2):153-167. doi: 10.17691/stm2015.7.2.20


20. Fishenko V.A., Demchyk R.M., Zasadnuk A.V., Ryshak A.D. Analiz rezyltatov stacionarnogo lecheniya zakritih perelomov lodijek. Travma. 2012;13(1):59-62.


21. Nikiforov D.A., Panin M.A., Procko V.G., Borgyt R.D., Aliev R.N. Povrejdenie distalnogo mejbercovogo sindesmoza, pyti ylychsheniya rezyltatov lecheniya (obzor literatyri). Genii ortopedii. 2022;28(1):141-149. doi: 10.18019/1028-4427-2022-28-1-141-149


22. Horoshkov S.N. Anatomo-biomehanicheskie kriterii differencirovannogo podhoda k lecheniu perelomov lodijek. Innovacii v travmatologii, ortopedii i reabilitologii. V kn. «Mejdynarodnoi naychno-prakticheskoi konferencii, posvyashennoi 55-letiu kafedri travmatologii i ortopedii ChGMA». Chita; 2024:185-193.


23. Jain S., Haughton B.A., Brew C. Intramedullary Fixation of Distal Fibular Fractures: a Systematic Review of Clinical and Functional Outcomes. J. Orthopaedics Traumatol. 2014;15(4):245-254. doi: 10.1007/s10195-014-0320-0


24. Saxena A., Yun A. Percutaneous plating of Weber B fibular fractures. J Foot Ankle Surg. 2017;56(2):366-370. doi: 10.1053/j.jfas.2016.11.012


25. Hamid K.S., Glisson R.R., Morash J.G., Matson A.P., DeOrio J.K. Simultaneous Intraoperative Measurement of Cadaver Ankle and Subtalar Joint Compression During Arthrodesis With Intramedullary Nail, Screws, and Tibiotalocalcaneal Plate. Foot Ankle Int. 2018;39(9):1128-1132. doi: 10.1177/1071100718774271


26. Wenger D., Henning H., Bergkvist D., Rogmark C. Fewer reoperations after posterolateral plate positioning compared with lateral plate positioning in ankle fractures - a retrospective study on 453 AO/OTA 44-B injuries. Injury. 2021;52(7):1999-2005. doi: 10.1016/j.injury.2021.04.008


27. Marazzi C., Wittauer M., Hirschmann M.T., Testa E.A. Minimally Invasive Plate Osteosynthesis (MIPO) versus Open Reduction and Internal Fixation (ORIF) in the Treatment of Distal Fibula Danis-Weber Types B and C Fractures. J. Orthop. Surg. Res. 2020;15(1):491. doi: 10.1186/s13018-020-02018-5


28. Yañez Arauz J.M. Minimally invasive treatment of AO B ankle fractures: Surgical technique and long-term outcomes. Foot Ankle Surg. 2021;27(7):742-749. doi: 10.1016/j.fas.2020.09.010


29. Sitnik A.A., Beleckii A.V., Kochybinskii A.V., Kryk A.N. Osteosintez perelomov malobercovoi kosti: ot nakostnogo k intramedyllyarnomy. Medicinskii jyrnal. 2023;2(84):37-42. doi: 10.51922/1818-426X.2023.2.37


30. Ward B, Parry J. Routine intramedullary screw versus plate fixation of lateral malleolus fractures. Eur J Orthop Surg Traumatol. 2025;35(1):222. doi: 10.1007/s00590-025-04341-1


31. Peek A.C., Fitzgerald C.E., Charalambides C. Syndesmosis screws: how many, what diameter, where and should they be removed? A literature review. Injury. 2014;45(8):1262-1267. doi:10.1016/j.injury.2014.05.003


32. Ibrahim I.O., Velasco B.T., Ye M.Y., Miller C.P., Kwon J.Y. Syndesmotic screw breakage may be more problematic than previously reported: increased rates of hardware removal secondary to pain with intraosseous screw breakage. Foot Ankle Spec. 2022;15(1):27-35. doi: 10.1177/1938640020932049


33. Alastuey-López D., Seral B., Pérez M.Á. Biomechanical evaluation of syndesmotic fixation techniques via finite element analysis: screw vs. suture button. Comput Methods Programs Biomed. 2021;208:106272. doi: 10.1016/j.cmpb.2021.106272


34. Laflamme M., Belzile E.L., Bédard L., Bekerom M.P.J., Glazebrook M., Pelet S. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma. 2015;29(5):216-223. doi: 10.1097/BOT.0000000000000245


35. Xu K., Zhang J., Zhang P., Liang Y., Hu J.L., Wang X., Wang J. Comparison of Suture-Button Versus Syndesmotic Screw in the Treatment of Distal Tibiofibular Syndesmosis Injury: A Meta-analysis. J Foot Ankle Surg. 2021;60(3):555-566, doi: 10.1053/j.jfas.2020.08.005


36. Begyn P.I., Tihonenkova O.V., Safronova A.A. Komputernoe modelirovanie stryktyr oporno-dvigatelnogo apparata. Modelirovanie, optimizaciya i informacionnie tehnologii. 2021;9(1). doi: 10.26102/2310-6018/2021.32.1.017


37. Rockov Z.A., Finkel R.A., Hashmi S.Z., Byrne C.T., Nigh E.D., Garfinkel J.H., Noori N.B., Pujari A., Lin C.A., Moon C.N., Marecek G.S., Vrahas M.S., Little M.T.M. Mid to long term follow up of early weightbearing after open reduction internal fixation of ankle fractures. Injury. 2025;56(2):112157. doi:10.1016/j.injury.2025.112157


38. Schepers T., Halm J.A. Aftercare for surgically treated ankle fractures. Lancet. 2024;403(10446):2756-2757. doi: 10.1016/S0140-6736(24)00916-4


39. Bretherton C. P., Achten J., Jogarah V., Petrou S., Peckham N., Achana F., Appelbe D., Kearney R., Claireux H., Bell P., Griffin X. L., WAX Investigators. Early versus delayed weight-bearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomized controlled trial. Lancet J. 2024;29;403(10446):2787-2797. doi: 10.1016/S0140-6736(24)00710-4


40. Cursaru A., Popa M., Lupu A., Iordache S., Costache M., Cretu B., Serban B., Cirstoiu C. An examination of personalized approaches in the management of ankle fractures: a thorough evaluation of soft tissue factors, treatment methods, and patient adherence. Cureus J. 2023;15:e45507. doi:10.7759/cureus.45507


41. Capenko V.O., Kashanskii U.B., Kondratev I.P., Polikarpov A.V., Vashetko R.V. Sovershenstvovanie tehnologii hiryrgicheskogo lecheniya postradavshih s perelomami lodijek. Medline.ru. Rossiiskii biomedicinskii jyrnal. 2023;24(2):1152-1159.

Журнал основан 16 ноября 2000г.
Выдано Министерством РФ по делам печати, телерадиовещания и средств массовых коммуникаций

(c) Перепечатка материалов сайта Medline.Ru возможна только с письменного разрешения редакции