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New intra-operative technique for testing the distal tibiofibular syndesmosis.

Ann R Coll Surg Engl 2010; 92: 257–266 258 BACKGROUND The intra-operative tests commonly in use when assessing for the presence of syndesmotic instability are the hook test and the external rotation stress test which have high inter-observer variance.1 Candal-Couto et al.2 showed that the anteroposterior mortise view correlated poorly with observed diastasis when using the hook test. We describe a new technique to test the inferior tibiofibular syndesmosis in ankle fractures.3 TECHNIQUE The fibular fracture is stabilised using plate and screws. Using the screw hole at an appropriate level, a drill hole is made through the near and far cortex of the fibula using 2.5-mm drill bit. A 3.5-mm tap is introduced to meet and push the near cortex of the tibia. If there is evidence of widening of the tibiofibular clear space on mortise view, the syndesmosis is stabilised by the surgeon’s preferred technique. If there is no evidence of syndesmotic instability, the screw hole is filled with a standard 3.5-mm screw.