Original Article

The Anatomical Changes in the Distal Tibio-Fibular Joint in Syndesmotic Injuries: A Fresh Cadaveric Study


  • Hülya Gürbüz
  • Mehmet Kürşad Bayraktar
  • Müjdat Adaş
  • Murat Çakar
  • Ali Çağrı Tekin
  • Cem Zeki Esenyel

Received Date: 23.03.2014 Accepted Date: 19.05.2014 Eur Arc Med Res 2014;30(2):86-90


The aim of this study is to investigate the changes in the distal tibio-fibular joint during the syndesmotic ligamentous injuries in the fresh cadavers.

Material and Methods:

Twenty below knee specimens of ten fresh cadavers were randomly divided in two equal groups. Anatomical and radiological changes of the ankle joint were examined via the dissection of syndesmotic ligaments. In the first group by the anterior approach and in the second group by the posterior approach syndesmotic ligaments were disected respectively. The anatomical dissociation in the distal tibio-fibular joint was measured. Radiological measurement were achieved by dynamic flouroscopic views.


In all steps of the dissection, anatomical dissociation was observed in the joint. There was no significant difference between two groups. When one of the ligaments was intact there was no significant change radiographically. In both series since the incisions included all of the layers anterior to posterior, significant increase of distal tibio-fibular joint seperation was observed. In the meantime a significant increase was measured in tibiofibuler clear space radiologically. Despite this, medial clear space and talo-crural angle changes were not detected.


Even when one of the syndesmotic ligaments is dissected, the anatomy of the distal tibio fibular joint is disrupted in the form of lateral separation which could not be imaged properly in X-Ray. Therefore, in the presence of clinical suspicion it is necessary to apply additional radiological diagnostic methods such as MRI.

Keywords: ankle injuries, cadaver, lateral ligament, syndesmosis