The purpose of this study is to show that the adequate reduction and repair of soft tissue in distal tibiofibuler syndesmosis including interosseous ligament is necessary for achieving an ankle stability following pronation-external rotation injury (PER) stage III, IV, pronation-abduction injury (PA) stage III. 19 cases of displaced bimalleolar and trimalleolar fractures of the ankle treated at our hospital were reviewed clinically. There were 14 males and 5 females with an average age of 40.8 years (range; 15 to 77 years). The average follow-up period was 6 years and 8 months (range; 1 to 11 years). PER stage III was seen in 3 cases, PER stage IV in 13 cases, and PA in 3 cases. Though all cases were treated by surgical intervention, treatment for distal tibiofibuler syndesmosis was varied by internal static fixation (I. F.), or repair of soft tissue (R. S.). Both I. F. and R. S. were performed on 5 cases, only I. F. on 8 cases, only R. S. on 3 cases, and neither I. F. nor R. S. on 3 cases.
We evaluated the width of the syndesmotic space in all initial and post operation roentgenogrms using the criteria of Leed, et al., in addition to physical examination. The correlation between I. F. and R. S. was then investigated. Postoperative tibiofibuler diastasis was not significant in the R. S. group (p<0.05). Moreover, the restriction of the range of motion and pain at weight bearing was relatively low in the I. F. group.