Overcompression of the syndesmosis in a geriatric ankle fracture-dislocation: A case report and surgical revision analysis

A prevalent, but under-reported, complication in any ankle fracture-dislocations is syndesmotic malreduction. Choosing the appropriate syndesmotic fixation construct can be challenging as each patient differs in their demographic and biomechanical profile. Dynamic syndesmotic fixation has increased in prevalence as compared to standard rigid syndesmotic fixation. The authors present a case report of a 79-year-old female with a bimalleolar fracture-dislocation initially treated with dynamic syndesmotic fixation. Postoperative imaging however, revealed fibular malreduction with syndesmotic overcompression. A revision procedure was required consisting of dynamic fixation removal and application of rigid quadricortical screw fixation. This case report illustrates the potential limitations and complications of difficult, hard to reduce syndesmotic injuries especially in a patient with compromised bone quality.