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Calcaneofibular ligament
2%
31/1470
Lateral ulnar collateral ligament of the elbow
1%
22/1470
Ligamentum flavum
0%
4/1470
Anterior talofibular ligament
3%
46/1470
Ankle syndesmosis
93%
1360/1470
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The inferior tibiofibular syndesmosis is a fibrous articulation consisting of four ligaments; the elasticity of these ligaments permits axial, vertical, anterior, posterior, and mediolateral motion at the ankle syndesmosis during weight bearing. Of note, the Cotton test was originally described around 1910 by Frederic J. Cotton as the "talar glide test" evaluating the medial/lateral translation of the talus in the mortise. A positive result indicates disruption of the ankle syndesmosis in the face of an ankle injury. Nielson et al reported that the level of the fibular fracture does not correlate reliably with the integrity or extent of the interosseous membrane (IOM) tears identified on MRI in operative ankle fractures. Therefore, one cannot consistently estimate the integrity of the IOM and subsequent need for transsyndesmotic fixation based solely on the level of the fibular fracture. This supports the need for intraoperative stress testing (ie, external rotation stress or Cotton test) of the ankle syndesmosis in all operative ankle fractures. The study by Leeds et al noted a correlation between syndesmosis reduction (initial and final) and outcomes (radiographic and clinical). The attached video shows the Cotton test during an ankle fixation procedure.
3.5
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