Rupture of the syndesmosis of the ankle joint, distal tibiofibular, and other types
Rupture of the syndesmosis: types, causes and methods of trauma-healing
In the human body bones can be connected as a movable and a stationary way.
The main form of connection joints, movable connections comprising mating pieces of bone, joint cavity, capsule and restraining ligaments. In smaller numbers there are syndesmosis.
This sedentary articulation of bones by means of a layer or bundle of dense connective tissue, present between the bones of the skull, lower leg, forearm, spinous processes of the vertebrae.
In the form of a layer of connective tissue syndesmoses can look like a membrane (membrane), the seam or «welding». The membrane is connected to the tibia with the fibula, and ulna with radial transverse surface of the vertebrae and their spinous processes.
In the form of sutures syndesmoses are present between the cranial bones. They are divided into flake, flat and toothed. The term «welding» refers to the connection between the tooth root and the inner surface of the alveoli.
Features of injury
The most frequently damaged interosseous membrane between the tibia in the lower third, front and rear SYNDESMOS included in the composition of ankle joint and involved in ensuring its stability.
Basically, the injury occurs in athletes when jumping or running, dancers, circus performers. It looks like isolated stretching or rupture of ligamentous bands, and as an combined with fractures or separation of a fragment of the ligament with a piece of bone.
Damage to cranial or vertebral syndesmosis always accompanied by traumatic brain or spinal injury.
In particular, due to birth trauma in newborns, the interosseous membrane of the skull can be broken or have a hemorrhage.
In compression fracture of the spine, where one vertebra is pressed into the other, interspinal and transverse syndesmosis often do not undergo complete rupture, but may be stretched or have partial damage to the fibers with hemorrhages.
Rupture of the tibiofibular membrane
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The tibiofibular syndesmosis is presented in the form of an inactive connective tissue membrane that connects the medial surface of the tibia and fibula along their entire length.
The main part of the membrane is called the interosseous membrane, only the lower part of it and actually called the tibiofibular syndesmosis.
Normal tibiofibular width of cracks not exceeding 3 mm. fibers of the Fibrous covering her, crossed or parallel to each other and are in several layers, of which the inner is more durable, but the exterior are more susceptible to sprains and tears.
This explains the possibility of partial rupture of the distal tibiofibular syndesmosis.
Almost all injuries of the lower leg, especially in the lower third, accompanied by injuries of the tibiofibular joints, and 10% of sprains in the ankle joint are «top», i.e. focused in the syndesmosis.
The majority of patients are athletes, experiencing the action of a lateral impact forces, football players and hockey players. Among them are frequent pushing, strong on her legs and falls.
From injury tibiofibular membrane, no one is immune, though certain professions (ballet, circus arts, choreography) increase their risk.
Breaks and sprains tibiofibular joint are included in the combined injuries in many car accidents and accidents, you can get them, falling on the slippery road or from a small height.
High heels also increase the possibility of injury. Most commonly there is a rupture membrane at the tibiofibular fracture and dislocation of the ankles, with severe pronation (turning outward) of the foot and simultaneously its rotation (turn sock inside).
In such an arrangement, a gap occurs along the line of attachment of the fibres to the tibia.
The clinical picture
The symptoms of injuries of the syndesmosis is composed of severe pain, aggravated by palpation and change the position of the foot, and swelling, growing with every minute.
Stop takes a forced, unnatural position (usually twisted outwards), the damage area is hyperemic, there is hemorrhage.
Radiography in such cases is mandatory. The pictures, taken in two projections, and with the stress on certain ligaments is clearly determined by the extension tibiofibular gap, the line gap, the presence of fractures.
With the help of radiographs to exclude sprain, partial rupture of membrane joint, and to clarify the treatment tactics.
Uncomplicated partial and complete rupture of the tibiofibular joints begin to heal with conservative methods.
For anesthesia is novocaine blockade. The main task is to completely immobilize the injured area, compress the expanded tibiofibular gap, to give time for the ligaments to repair themselves.
On the ankle a plaster in the form of a boot for 5-6 weeks. He then removed, replaced by a removable splint for another 2 weeks. At the same time begin to carry out physiotherapy, massage, do therapeutic exercises.
Conservative treatment is long and not always 100% effective. For another 6 months can lead to decreased functionality and pain.
Surgery also method
In advanced or complicated forms to rupture of the tibiofibular articulation (failure of conservative attempts to close the gap between the bones of the lower leg, incorrectly fused fractures of the ankles) therapy is the use of surgical methods.
Of them traditionally used two ways:
- The first is endoplasmic, that is the replanting part of the broad fascia of the thigh, canned tendons or strips of Dacron in place of the torn syndesmosis, its full upgrade. The new ligament is implanted in the channels drilled in the tibia bones. The percentage of full recovery – 92 is a very good result.
- The second surgical method gives the greatest strength to the fork of the ankle is the use of a bolt tie strap or hip compression screw. Its essence is to install a reliable tightening mechanism of the special metallosplav that fixes the Shin bone at a certain distance from each other, not allowing them to coalesce or to move, and prevents contracture of the ankle joint.
Breaks tibiofibular membrane are accompanied by vascular disorders. Sometimes, possible thrombosis of the venous vessels. To prevent such complications are assigned to anticoagulants, amyotrophia means that speeds recovery.
Features of injury to the ankle joint
The syndesmosis of the ankle joint formed by the interosseous membrane, and lateral, front and rear tibiofibular ligaments.
It securely locks the ankle, not allowing its components to move relative to each other. Injuries to the syndesmosis occur quite often: 20% of all damage to the supporting apparatus.
Of them 12% are partial and complete tears of the ligaments.
The cause of trauma
Cause of injury – the effect of lateral or direct force on the joint.
A variety of punches, collisions, slipping or falling with povertyline of the foot is the most common etiological factors.
Symptoms of sprains and ruptures of ankle syndesmosis similar: sharp pain, redness and increasing swelling of the joint, bruising, gentle and unnatural position of the foot, its deformation.
Often trauma is combined with malleolar fracture with displacement and without it. To make a differential diagnosis will help radiography.
In the images in multiple projections clearly differentialsa the status of all ligaments and bony components of the joint.
Treatment after the injury
Therapy fresh (20 days) injuries of the ankle syndesmosis is conservative.
It consists of local anesthesia, reposition and fixation of the foot in the normal position, the imposition of a plaster bandage and complete rest.
Chronic tears (more than 20 days) it is better to treat surgically. Possible ligament sew or make them plastic, at the same time in the presence of the fracture fragments are fixed with metal structures.
Prevention of injury
Prevention of injuries of the syndesmosis are wearing supportive shoes with a wide and low heel, caution on the ice, while running and jumping.
It is necessary to strengthen the ligaments nutritious meals, exercise all possible sports. Professional athletes use special fixing bandage.
Therapy injuries syndesmosis should start on time as the running time longer and harder. Proper and competent treatment restores function of the joint in full.