Description of patient (type of occupation, indication of age, intensity of sport):

A 16-year-old healthy female.

History and previous treatment:

Sprain ankle 8 months ago.

Current complaints:

Pain on exercise.

Physical examination:

Pain on anterior syndesmosis. Negative pain on stress of external rotation.


No maisonaive fracture. Increase syndesmotic space.
[Picture 1]

Additional investigation (CT/MRI):
CT shows increased syndesmotic clear space.
[Picture 2]

MRI shows a tear anterior syndesmosis, fracture posterior malleolus, small, nondisplcaced.
[Picture 3 + 4]


Case summary:

A 16-year-old healthy female with a painful syndesmotic injury/tear.

Question(s) to this case:

How aggressive should I be? Watchful waiting? Arthroscopy with debridement? Reduction and fiberwire? Full reconsctruction?


Since there is widening of the syndesmosis I would advise to fix with a fiberwire.
If you are in doubt on the instability you could start with investigation with arthroscopy.
Perform debridement of the syndesmotic area to stimulate fibrous tissue between tibia and fibula in the intrinsic syndesmotic space.