This 2007 JAAOS narrative review by Zalavras and Thordarson covers the anatomy, diagnosis, and management of ankle syndesmotic injury — both in isolation and in association with ankle fractures — addressing when instability is truly present and when surgical fixation is warranted.
When you see an ankle fracture — even a low Weber B. Don't rely on preoperative radiographs or fracture location to clear the syndesmosis: stress test intraoperatively after every bimalleolar fixation, because static criteria miss instability in over a third of cases.
What you fix matters less than how well you reduce it. Malreduced syndesmosis is the single strongest predictor of a bad functional outcome.
This 2007 JAAOS narrative review by Zalavras and Thordarson covers the anatomy, diagnosis, and management of ankle syndesmotic injury — both in isolation and in association with ankle fractures — addressing when instability is truly present and when surgical fixation is warranted.
When you see an ankle fracture — even a low Weber B. Don't rely on preoperative radiographs or fracture location to clear the syndesmosis: stress test intraoperatively after every bimalleolar fixation, because static criteria miss instability in over a third of cases.
What you fix matters less than how well you reduce it. Malreduced syndesmosis is the single strongest predictor of a bad functional outcome.