PMC4898177_01
59-year-old woman with right fibular fracture. AP radiograph of the right ankle demonstrates fracture of the distal one-third shaft of the fibula and widening of the distal tibiofibular joint with the tibia medially dislocated. Findings are consistent with a Weber C fracture with syndesmotic disruption.
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59-year-old woman with right fibular fracture. Plain radiograph of the right ankle shows lateral plate and screw internal fixation of the distal fibula fracture, which has healed. There are also three syndesmotic screws with surrounding lucency, suggestive of loosening. Widening of the distal tibiofibular joint and heterotopic ossification is seen.
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Plain radiographs of the ankle demonstrated widening of the lateral ankle mortise and lucency surrounding all three syndesmotic screws, concerning for hardware loosening (Fig. 2).
59-year-old woman with right fibular fracture. Coronal-plane weight-bearing CT of the right ankle in bone window demonstrates widening of the distal tibiofibular joint.
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59-year-old woman with right fibular fracture. AP radiograph of the right ankle demonstrates a new lateral fibular plate with one fibular screw and three syndesmotic screws. A radiolucent transverse tunnel is seen parallel to the plafond, consistent with the Tightrope  suture system. An oblong button is present along the medial tibia cortex, and a round button is present against the distal hole of the fibular plate. Widening of the distal tibiofibular joint has been reduced.
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Postoperative radiographs demonstrated a lucent tunnel extending transversely across the syndesmosis, secured by metal buttons along the distal medial tibial and lateral fibular cortices (Fig. 4).
59-year-old woman with right fibular fracture. Axial CT of the right ankle in bone window demonstrates a round metal button along the medial tibial cortex and a low attenuation tunnel extending along the tibiofibular joint.
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Postoperative CT demonstrated reduction of the lateral ankle mortise widening and a new lucent tunnel parallel to the ankle plafond, traversing the syndesmosis and secured by two metal buttons (Figure 5a, Figure 5b).