Rupture of the inferior tibiofibular syndesmosis: What options?

Rupture of the inferior tibiofibular syndesmosis (ITFS) due to damage to the tibiofibular ligaments and interosseous membrane is a fairly common associated lesion of malleolar fractures but is often unrecognized posing a twofold diagnostic and therapeutic problem.Through a prospective study over a period of 10 years from 1997 to 2007 in the Department of Orthopaedic and Traumatologic Surgery of the AZIZA OTHMANA Hospital (currently the Ben Arous Traumatology Center - Tunisia) which involved 40 malleolar fractures with ruptures of the STFI and through a review of the current literature we will successively answer the questions that an orthopaedic surgeon might ask himself when faced with a rupture of the STFI:- When should a rupture of the STFI be suspected?- How to confirm the diagnosis of a ruptured STFI?- When should a rupture of the STFI be treated?- What are the techniques for repairing the STFI?- How do you screw in the STFI? Which screws to use? How many screws? Where to put the screws? What are the postoperative procedures? When to remove the screws?- What should be done in case of an old STFI lesion?