Description of patient (type of occupation, indication of age, intensity of sport):
A 32 year old male.
History and previous treatment:
In 2014 sport injury. Weber-C type right ankle fracture. ORIF, after conventional rehabilitation period good ankle motion, return to sport activity. Implant removal after 7 months.
Current complaints:
After 1 year of removal surgery good function, but painful bump up to the ankle joint, especially after sport activity.
Physical examination:
No impingement, no instability, no synovitis, full ROM, no neurovascular abnormality, but hard, sensible prominence up to the syndesmotic area.
Radiology:
X-ray:
[Picture 2 + 3]: X-rays show tibiofibular synostosis.
[Picture 3 + 4]: Additional investigation (CT/MRI):
The painful area signed with arrow on CT 3D reconstruction.
Images:
Case summary:
Two 2 years after lateral ankle ORIF, and implant removal, good ankle joint function but tenderness over the tibiofibular synostosis.
Question(s) to this case:
What to do with this patient?
The operation and removal of synostosis is a good therapeutic option?
Is this syndesmotic junction stable enough after the removal of the synostosis?
Expert:
The synostosis itself is not the cause of the complaints, but in this case apparently the prominence.
You could remove the prominence but retain the synostosis by creating a new synostosis just below the old one. Use cancellous bone graft from the iliac crest and a 3 small tubular plate.