DELTOID AND SYNDESMOSIS LIGAMENT INJURY OF THE ANKLE WITHOUT FRACTURE

Ankle diastasis without fracture is a rare injury with few examples re ported. We report on four male patients, aged 16 to 18 years, who sust ained this injury playing football. Swelling and tenderness over both the deltoid and syndesmosis ligaments are the most common physical fin dings. Plain ankle radiographs demonstrated lateral talus subluxation in three patients, and a stress radiograph demonstrated subluxation of the talus in one patient. Treatment consisted of reduction and fixati on of the syndesmosis with a screw followed by 6 weeks of cast immobil ization. Using the scale developed by Edwards and DeLee, three patient s had excellent results and one had a good result. Diagnosis of tears of the deltoid and syndesmosis ligaments without fracture requires a h igh index of suspicion on the physician's part. In patients whose mort ise is more than 1 mm subluxated, reduction and screw fixation will pr oduce good results.