Cotton Test

Video Description

This is a video depicting the Cotton test of the ankle, which evaluates the syndesmosis for injury after fixation of malleolar fractures. In this technique, laterally-based distraction is used on the distal fibula at the level of the syndesmosis. Any opening of the syndesmosis, commonly seen as loss of the tib-fib overlap, is indicative of a syndesmotic injury requiring reduction and fixation.

Dr. Mizel's paper, referenced below, is an excellent review of the technique:

Mizel MS. Technique tip: a revised method of the Cotton test for intra-operative evaluation of syndesmotic injuries. Foot Ankle Int. 2003
Jan;24(1):86-7. Level of Evidence: 5 - Other. PMID: 12540089 (Link to Pubmed)