This narrative review by Hunt et al. examines syndesmotic (high ankle) injuries in athletes — covering anatomy, epidemiology, diagnostic workup, grading classification, and management from conservative rehab through surgical fixation. It addresses the central clinical question: how do you distinguish stable from unstable syndesmotic injuries, and what do you do about each?
When you see a high ankle sprain, your primary job is ruling out instability: weight-bearing and stress radiographs first, MRI if grade is unclear, and arthroscopy if dynamic instability is suspected (syndesmotic widening >2 mm or a 3.5-mm shaver fitting into the joint warrants fixation).
For surgical cases, suture button fixation offers a meaningful reduction accuracy advantage over screws — but make sure your construct runs along the intermalleolar axis, and watch for obesity as your strongest predictor of fixation failure.
This narrative review by Hunt et al. examines syndesmotic (high ankle) injuries in athletes — covering anatomy, epidemiology, diagnostic workup, grading classification, and management from conservative rehab through surgical fixation. It addresses the central clinical question: how do you distinguish stable from unstable syndesmotic injuries, and what do you do about each?
When you see a high ankle sprain, your primary job is ruling out instability: weight-bearing and stress radiographs first, MRI if grade is unclear, and arthroscopy if dynamic instability is suspected (syndesmotic widening >2 mm or a 3.5-mm shaver fitting into the joint warrants fixation).
For surgical cases, suture button fixation offers a meaningful reduction accuracy advantage over screws — but make sure your construct runs along the intermalleolar axis, and watch for obesity as your strongest predictor of fixation failure.