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.
After 1 year of removal surgery good function, but painful bump up to the ankle joint, especially after sport activity.
No impingement, no instability, no synovitis, full ROM, no neurovascular abnormality, but hard, sensible prominence up to the syndesmotic area.
[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.
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?
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.