# Functional Syndesmotic Widening: A Case Report and Literature Review

## TL;DR

This case report describes a rare ankle injury in a young man, where a syndesmotic widening led to complications after surgery.

## Contribution

The paper presents the first case of functional syndesmotic widening in a young, previously obese adult.

## Key findings

- The patient showed syndesmosis widening on plain radiographs after an ankle injury.
- Endobutton fixation resulted in talus subluxation and limited ankle dorsiflexion.
- Childhood obesity is proposed as a potential contributor to functional syndesmotic widening.

## Abstract

Injury to the distal tibiofibular syndesmosis can be a diagnostic challenge in the absence of advanced imaging. We report a case of a 21-year-old male patient who sustained an ankle injury and demonstrated radiological evidence of syndesmosis widening on plain radiographs. He underwent endobutton fixation which resulted in anterior subluxation of the talus and difficulty in ankle dorsiflexion. This is the first case report in the literature of a functional syndesmotic widening and the subsequent sequelae when subjected to a stabilisation procedure. The previously reported risk factors were inconsistent with our patient’s demographics of a young, previously obese adult. We postulate that his childhood morbid obesity likely contributed to the functional widening of his ankle syndesmosis.