Post-traumatic tibiofibular synostosis may occur following a high ankle sprain where the interosseous membrane was disrupted. The heterotopic ossification usually develops within 6 to 12 months. Typically, patients are able to return to sports despite the lack of normal ankle dorsiflexion and mobility between the tibia and fibula. Surgical excision is reserved for persistent pain that fails to respond to nonsurgical management once the ossification is “cold” (does not show increased uptake) on bone scan.
Whiteside et al described the first case series back in 1978 with 6 professional athletes who developed a tib-fib synostosis following high ankle sprain. Henry subsequently described it in professional basketball players.
Albers et al reported on 15 synostoses following 230 operatively treated ankle fracture. These were usually Weber C fractures and their result at final follow-up was similar to other patients without synostoses.
Whiteside LA, Reynolds FC, Ellsasser JC. Tibiofibular synostosis and recurrent ankle sprains in high performance athletes.Am J Sports Med. 1978 Jul-Aug;6(4):204-8.
PMID:686231 (Link to Abstract)
Henry JH, Andersen AJ, Cothren CC. Tibiofibular synostosis in professional basketball players. Am J Sports Med 1993;21:619-622.
PMID:8368426 (Link to Abstract)
Albers GH, de Kort AF, Middendorf PR, van Dijk CN. Distal tibiofibular synostosis after ankle fracture: a 14-year follow-up study. J Bone Joint Surg [Br] 1996;78-B:250-2.
PMID:8666636 (Link to Abstract)