{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:56:33Z","timestamp":1793105793408,"version":"4.5.0"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T00:00:00Z","timestamp":1649635200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T00:00:00Z","timestamp":1649635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Private Universit\u00e4t Witten\/Herdecke gGmbH"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Although non-fracture-related syndesmotic injuries of the ankle are relatively rare, they may lead to poor clinical outcome if initially undiagnosed or managed improperly. Despite a variety of literature regarding possibilities for treatment of isolated syndesmotic injuries, little is known about effective applications of different therapeutic methods in day-to-day work. The aim of this study was to assess the current status of the treatment of isolated syndesmotic injuries in Germany.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>An online-questionnaire, capturing the routine diagnostic workup including clinical examination, radiologic assessment and treatment strategies, was sent to all members of the German Society of Orthopedic Surgery and Traumatology (DGOU) and Association of Arthroscopic and Joint Surgery (AGA). Statistical analysis was performed using Microsoft excel and SPSS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Each question of the questionnaire was on average answered by 431\u2009\u00b1\u2009113 respondents. External rotation stress test (66%), squeeze test (61%) and forced dorsiflexion test (40%) were most commonly used for the clinical examination. In the diagnostic workup, most clinicians relied on MRI (83%) and conventional X-ray analysis (anterior\u2013posterior 58%, lateral 41%, mortise view 38%). Only 15% of the respondents stated that there is a role for arthroscopic evaluation for the assessment of isolated syndesmotic injuries. Most frequently used fixation techniques included syndesmotic screw fixation (80%, 42% one syndesmotic screw, 38% two syndesmotic screws), followed by suture-button devices in 13%. Syndesmotic screw fixation was mainly performed tricortically (78%). While 50% of the respondents stated that syndesmotic screw fixation and suture-button devices are equivalent in the treatment of isolated syndesmotic injuries with respect to clinical outcome, 36% answered that syndesmotic screw fixation is superior compared to suture-button devices.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>While arthroscopy and suture-button devices do not appear to be widely used, syndesmotic screw fixation after diagnostic work-up by MRI seems to be the common treatment algorithm for non-fracture-related syndesmotic injuries in Germany.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-022-04423-3","type":"journal-article","created":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T10:07:08Z","timestamp":1649671628000},"page":"2019-2026","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Current status of the management of isolated syndesmotic injuries in Germany"],"prefix":"10.1007","volume":"143","author":[{"given":"Manuel","family":"Mutschler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Hendrik","family":"Naendrup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"Pfeiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Jaecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dariusch","family":"Arbab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Shafizadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Buchhorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,11]]},"reference":[{"issue":"1","key":"4423_CR1","doi-asserted-by":"publisher","first-page":"73","DOI":"10.2165\/00007256-200737010-00006","volume":"37","author":"D Fong","year":"2007","unstructured":"Fong D, Hong Y, Chan L et al (2007) A systematic review on ankle injury and ankle sprain in sports. Sports Med 37(1):73\u201379. https:\/\/doi.org\/10.2165\/00007256-200737010-00006","journal-title":"Sports Med"},{"issue":"1","key":"4423_CR2","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/S40279-013-0102-5","volume":"44","author":"C Doherty","year":"2014","unstructured":"Doherty C, Delahunt E, Caulfield B et al (2014) The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med 44(1):123\u2013140. https:\/\/doi.org\/10.1007\/S40279-013-0102-5","journal-title":"Sports Med"},{"issue":"6","key":"4423_CR3","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1177\/1941738116659639","volume":"8","author":"S Shah","year":"2016","unstructured":"Shah S, Thomas AC, Noone JM et al (2016) Incidence and cost of ankle sprains in United states emergency departments. Sports Health 8(6):547\u2013552. https:\/\/doi.org\/10.1177\/1941738116659639","journal-title":"Sports Health"},{"issue":"6","key":"4423_CR4","doi-asserted-by":"publisher","first-page":"603","DOI":"10.4085\/1062-6050-447-17","volume":"54","author":"MM Herzog","year":"2019","unstructured":"Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA (2019) Epidemiology of ankle sprains and chronic ankle instability. J Athl Train 54(6):603\u2013610. https:\/\/doi.org\/10.4085\/1062-6050-447-17","journal-title":"J Athl Train"},{"issue":"5","key":"4423_CR5","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1177\/0363546510391462","volume":"39","author":"B Waterman","year":"2011","unstructured":"Waterman B, Belmont P, Cameron K et al (2011) Risk factors for syndesmotic and medial ankle sprain: role of sex, sport, and level of competition. Am J Sports Med 39(5):992\u2013998. https:\/\/doi.org\/10.1177\/0363546510391462","journal-title":"Am J Sports Med"},{"issue":"1","key":"4423_CR6","first-page":"68","volume":"36","author":"SA Norkus","year":"2001","unstructured":"Norkus SA, Floyd RT (2001) The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train 36(1):68\u201373","journal-title":"J Athl Train"},{"issue":"6","key":"4423_CR7","doi-asserted-by":"publisher","first-page":"372","DOI":"10.2519\/JOSPT.2006.2195","volume":"36","author":"C Lin","year":"2006","unstructured":"Lin C, Gross M, Weinhold P (2006) Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther 36(6):372\u2013384. https:\/\/doi.org\/10.2519\/JOSPT.2006.2195","journal-title":"J Orthop Sports Phys Ther"},{"issue":"3","key":"4423_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4172\/2329-910X.1000281","volume":"6","author":"P DHooghe","year":"2018","unstructured":"DHooghe P, Joyce C, Hunt K, Kaux J (2018) Concomitant injuries in chronic ankle instability. Clin Res Foot Ankle 6(3):1\u20137. https:\/\/doi.org\/10.4172\/2329-910X.1000281","journal-title":"Clin Res Foot Ankle"},{"issue":"11","key":"4423_CR9","doi-asserted-by":"publisher","first-page":"2167","DOI":"10.1177\/0363546508319050","volume":"36","author":"WJ Choi","year":"2008","unstructured":"Choi WJ, Lee JW, Han SH et al (2008) Chronic lateral ankle instability. Am J Sports Med 36(11):2167\u20132172. https:\/\/doi.org\/10.1177\/0363546508319050","journal-title":"Am J Sports Med"},{"issue":"3","key":"4423_CR10","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1002\/JOR.23462","volume":"35","author":"ML Delco","year":"2017","unstructured":"Delco ML, Kennedy JG, Bonassar LJ, Fortier LA (2017) Post-traumatic osteoarthritis of the ankle: a distinct clinical entity requiring new research approaches. J Orthop Res 35(3):440\u2013453. https:\/\/doi.org\/10.1002\/JOR.23462","journal-title":"J Orthop Res"},{"issue":"24","key":"4423_CR11","doi-asserted-by":"publisher","first-page":"1496","DOI":"10.1136\/BJSPORTS-2016-096189","volume":"50","author":"P Gribble","year":"2016","unstructured":"Gribble P, Bleakley C, Caulfield B et al (2016) Evidence review for the 2016 International ankle consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 50(24):1496\u20131505. https:\/\/doi.org\/10.1136\/BJSPORTS-2016-096189","journal-title":"Br J Sports Med"},{"issue":"2","key":"4423_CR12","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/J.PTSP.2011.03.001","volume":"12","author":"E Mulligan","year":"2011","unstructured":"Mulligan E (2011) Evaluation and management of ankle syndesmosis injuries. Phys Ther Sport 12(2):57\u201359. https:\/\/doi.org\/10.1016\/J.PTSP.2011.03.001","journal-title":"Phys Ther Sport"},{"issue":"10","key":"4423_CR13","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1136\/BJSPORTS-2012-091702","volume":"47","author":"ADA Sman","year":"2013","unstructured":"Sman ADA, Hiller CEC, Refshauge KKM (2013) Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med 47(10):620\u2013628. https:\/\/doi.org\/10.1136\/BJSPORTS-2012-091702","journal-title":"Br J Sports Med"},{"issue":"4","key":"4423_CR14","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1007\/S12178-013-9184-9","volume":"6","author":"KJ Hunt","year":"2013","unstructured":"Hunt KJ (2013) Syndesmosis injuries. Curr Rev Musculoskelet Med 6(4):304\u2013312. https:\/\/doi.org\/10.1007\/S12178-013-9184-9","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"1","key":"4423_CR15","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1148\/RADIOL.2271011865","volume":"227","author":"K Oae","year":"2003","unstructured":"Oae K, Takao M, Naito K et al (2003) Injury of the tibiofibular syndesmosis: value of MR imaging for diagnosis. Radiology 227(1):155\u2013161. https:\/\/doi.org\/10.1148\/RADIOL.2271011865","journal-title":"Radiology"},{"issue":"3","key":"4423_CR16","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1302\/0301-620X.85B3.13174","volume":"85","author":"M Takao","year":"2003","unstructured":"Takao M, Ochi M, Oae K et al (2003) Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle. J Bone Joint Surg Br 85(3):324\u2013329. https:\/\/doi.org\/10.1302\/0301-620X.85B3.13174","journal-title":"J Bone Joint Surg Br"},{"issue":"5","key":"4423_CR17","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1007\/S00256-017-2823-2","volume":"47","author":"N Kr\u00e4henb\u00fchl","year":"2018","unstructured":"Kr\u00e4henb\u00fchl N, Weinberg N, Davidson N et al (2018) Imaging in syndesmotic injury: a systematic literature review. Skeletal Radiol 47(5):631\u2013648. https:\/\/doi.org\/10.1007\/S00256-017-2823-2","journal-title":"Skeletal Radiol"},{"issue":"6","key":"4423_CR18","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/S00068-014-0466-8","volume":"41","author":"S Rammelt","year":"2015","unstructured":"Rammelt S, Obruba P (2015) An update on the evaluation and treatment of syndesmotic injuries. Eur J Trauma Emerg Surg 41(6):601\u2013614. https:\/\/doi.org\/10.1007\/S00068-014-0466-8","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"3","key":"4423_CR19","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/J.OCL.2019.02.004","volume":"50","author":"C Akoh","year":"2019","unstructured":"Akoh C, Phisitkul P (2019) Anatomic ligament repairs of syndesmotic injuries. Orthop Clin North Am 50(3):401\u2013414. https:\/\/doi.org\/10.1016\/J.OCL.2019.02.004","journal-title":"Orthop Clin North Am"},{"issue":"6","key":"4423_CR20","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1053\/J.JFAS.2019.01.015","volume":"58","author":"G Liu","year":"2019","unstructured":"Liu G, Chen L, Gong M et al (2019) Clinical evidence for treatment of distal tibiofibular syndesmosis injury: a systematic review of clinical studies. J Foot Ankle Surg 58(6):1245\u20131250. https:\/\/doi.org\/10.1053\/J.JFAS.2019.01.015","journal-title":"J Foot Ankle Surg"},{"issue":"1","key":"4423_CR21","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1186\/s12891-017-1645-7","volume":"18","author":"P Zhang","year":"2017","unstructured":"Zhang P, Liang Y, He J et al (2017) A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury. BMC Musculoskelet Disord 18(1):286. https:\/\/doi.org\/10.1186\/s12891-017-1645-7","journal-title":"BMC Musculoskelet Disord"},{"issue":"6","key":"4423_CR22","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1177\/1941738110384573","volume":"2","author":"GN Williams","year":"2010","unstructured":"Williams GN, Allen EJ (2010) Rehabilitation of syndesmotic (high) ankle sprains. Sports Health 2(6):460\u2013470. https:\/\/doi.org\/10.1177\/1941738110384573","journal-title":"Sports Health"},{"issue":"1","key":"4423_CR23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2016-000175","volume":"3","author":"AJ Latham","year":"2017","unstructured":"Latham AJ, Goodwin PC, Stirling B, Budgen A (2017) Ankle syndesmosis repair and rehabilitation in professional rugby league players: a case series report. BMJ Open Sport Exerc Med 3(1):e000175. https:\/\/doi.org\/10.1136\/bmjsem-2016-000175","journal-title":"BMJ Open Sport Exerc Med"},{"issue":"4","key":"4423_CR24","doi-asserted-by":"publisher","first-page":"197","DOI":"10.2519\/JOSPT.1995.21.4.197","volume":"21","author":"T Brosky","year":"1995","unstructured":"Brosky T, Nyland J, Nitz A, Caborn D (1995) The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation. J Orthop Sports Phys Ther 21(4):197\u2013205. https:\/\/doi.org\/10.2519\/JOSPT.1995.21.4.197","journal-title":"J Orthop Sports Phys Ther"},{"key":"4423_CR25","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.ptsp.2021.03.005","volume":"49","author":"F Netterstr\u00f6m-Wedin","year":"2021","unstructured":"Netterstr\u00f6m-Wedin F, Bleakley C (2021) Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: a systematic review with meta-analysis. Phys Ther Sport 49:214\u2013226. https:\/\/doi.org\/10.1016\/j.ptsp.2021.03.005","journal-title":"Phys Ther Sport"},{"issue":"4","key":"4423_CR26","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1007\/s11999-009-1131-0","volume":"468","author":"PJ O\u2019Neill","year":"2010","unstructured":"O\u2019Neill PJ, Van Aman SE, Guyton GP (2010) Is MRI adequate to detect lesions in patients with ankle instability? Clin Orthop Relat Res 468(4):1115\u20131119. https:\/\/doi.org\/10.1007\/s11999-009-1131-0","journal-title":"Clin Orthop Relat Res"},{"issue":"3","key":"4423_CR27","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1177\/1071100714553469","volume":"36","author":"CC Gatlin","year":"2015","unstructured":"Gatlin CC, Matheny LM, Ho CP et al (2015) Diagnostic accuracy of 3.0 tesla magnetic resonance imaging for the detection of articular cartilage lesions of the talus. Foot Ankle Int 36(3):288\u2013292. https:\/\/doi.org\/10.1177\/1071100714553469","journal-title":"Foot Ankle Int"},{"issue":"9","key":"4423_CR28","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1097\/RLI.0b013e31817e9ada","volume":"43","author":"JS Bauer","year":"2008","unstructured":"Bauer JS, Barr C, Henning TD et al (2008) Magnetic resonance imaging of the ankle at 3.0 tesla and 1.5 tesla in human cadaver specimens with artificially created lesions of cartilage and ligaments. Invest Radiol 43(9):604\u2013611. https:\/\/doi.org\/10.1097\/RLI.0b013e31817e9ada","journal-title":"Invest Radiol"},{"issue":"5","key":"4423_CR29","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1007\/s00167-020-06141-y","volume":"29","author":"K Rellensmann","year":"2020","unstructured":"Rellensmann K, Behzadi C, Usseglio J et al (2020) Acute, isolated and unstable syndesmotic injuries are frequently associated with intra-articular pathologies. Knee Surg Sport Traumatol Arthrosc 29(5):1516\u20131522. https:\/\/doi.org\/10.1007\/s00167-020-06141-y","journal-title":"Knee Surg Sport Traumatol Arthrosc"},{"issue":"6","key":"4423_CR30","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1177\/1938640016666913","volume":"9","author":"DE Lucas","year":"2016","unstructured":"Lucas DE, Watson BC, Simpson GA et al (2016) Arthroscopic evaluation of syndesmotic instability and malreduction. Foot Ankle Spec 9(6):500\u2013505. https:\/\/doi.org\/10.1177\/1938640016666913","journal-title":"Foot Ankle Spec"},{"issue":"1","key":"4423_CR31","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1007\/s00167-020-06067-5","volume":"29","author":"NC Hagemeijer","year":"2021","unstructured":"Hagemeijer NC, Elghazy MA, Waryasz G et al (2021) Arthroscopic coronal plane syndesmotic instability has been over-diagnosed. Knee Surg Sports Traumatol Arthrosc 29(1):310\u2013323. https:\/\/doi.org\/10.1007\/s00167-020-06067-5","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"6","key":"4423_CR32","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1053\/j.jfas.2018.05.014","volume":"57","author":"M Turky","year":"2018","unstructured":"Turky M, Menon KV, Saeed K (2018) Arthroscopic grading of injuries of the inferior tibiofibular syndesmosis. J Foot Ankle Surg 57(6):1125\u20131129. https:\/\/doi.org\/10.1053\/j.jfas.2018.05.014","journal-title":"J Foot Ankle Surg"},{"key":"4423_CR33","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1111\/1754-9485.12708","volume":"62","author":"JJ Kellett","year":"2018","unstructured":"Kellett JJ, Lovell GA, Eriksen DA, Sampson MJ (2018) Diagnostic imaging of ankle syndesmosis injuries: a general review. J Med Imaging Radiat Oncol 62:159\u2013168. https:\/\/doi.org\/10.1111\/1754-9485.12708","journal-title":"J Med Imaging Radiat Oncol"},{"key":"4423_CR34","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1007\/s00402-021-03813-3","volume":"141","author":"DRC Nishikawa","year":"2021","unstructured":"Nishikawa DRC, Saito GH, de Oliveira Junior AS et al (2021) Clinical outcomes of isolated acute instability of the syndesmosis treated with arthroscopy and percutaneous suture-button fixation. Arch Orthop Trauma Surg 141:1567\u20131574. https:\/\/doi.org\/10.1007\/s00402-021-03813-3","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"4423_CR35","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s00167-019-05813-8","volume":"28","author":"J Vega","year":"2020","unstructured":"Vega J, Karlsson J, Kerkhoffs GMMJ, Dalmau-Pastor M (2020) Ankle arthroscopy: the wave that\u2019s coming. Knee Surg Sport Traumatol Arthrosc 28(1):5\u20137. https:\/\/doi.org\/10.1007\/s00167-019-05813-8","journal-title":"Knee Surg Sport Traumatol Arthrosc"},{"issue":"1","key":"4423_CR36","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s40634-020-00234-w","volume":"7","author":"NK Patel","year":"2020","unstructured":"Patel NK, Murphy CI, Pfeiffer TR et al (2020) Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study. J Exp Orthop 7(1):18. https:\/\/doi.org\/10.1186\/s40634-020-00234-w","journal-title":"J Exp Orthop"},{"issue":"3","key":"4423_CR37","doi-asserted-by":"publisher","first-page":"356","DOI":"10.2106\/00004623-197658030-00010","volume":"58","author":"PL Ramsey","year":"1976","unstructured":"Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Jt Surg Ser A 58(3):356\u2013357. https:\/\/doi.org\/10.2106\/00004623-197658030-00010","journal-title":"J Bone Jt Surg Ser A"},{"issue":"11","key":"4423_CR38","doi-asserted-by":"publisher","first-page":"2764","DOI":"10.1177\/0363546518804804","volume":"47","author":"Y Shimozono","year":"2019","unstructured":"Shimozono Y, Hurley ET, Myerson CL et al (2019) Suture button versus syndesmotic screw for syndesmosis injuries: a meta-analysis of randomized controlled trials. Am J Sports Med 47(11):2764\u20132771. https:\/\/doi.org\/10.1177\/0363546518804804","journal-title":"Am J Sports Med"},{"issue":"1","key":"4423_CR39","doi-asserted-by":"publisher","first-page":"2","DOI":"10.2106\/JBJS.16.01011","volume":"100","author":"MR Andersen","year":"2018","unstructured":"Andersen MR, Frihagen F, Hellund JC et al (2018) Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury. J Bone Joint Surg Am 100(1):2\u201312. https:\/\/doi.org\/10.2106\/JBJS.16.01011","journal-title":"J Bone Joint Surg Am"},{"key":"4423_CR40","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1097\/BOT.0000000000001559","volume":"33","author":"D Sanders","year":"2019","unstructured":"Sanders D, Schneider P, Taylor M et al (2019) Improved reduction of the tibiofibular syndesmosis with tightrope compared with screw fixation: results of a randomized controlled study. J Orthop Trauma 33:531\u2013537. https:\/\/doi.org\/10.1097\/BOT.0000000000001559","journal-title":"J Orthop Trauma"},{"key":"4423_CR41","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-021-04073-x","author":"R Hennings","year":"2021","unstructured":"Hennings R, Spiegl UJ, Fuchs C et al (2021) Does the orientation of syndesmosis fixative device affect the immediate reduction of the distal tibiofibular joint? Arch Orthop Trauma Surg. https:\/\/doi.org\/10.1007\/s00402-021-04073-x","journal-title":"Arch Orthop Trauma Surg"},{"key":"4423_CR42","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.2106\/JBJS.K.01122","volume":"94","author":"J Franke","year":"2012","unstructured":"Franke J, von Recum J, Suda AJ et al (2012) Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries. J Bone Joint Surg Am 94:1386\u20131390. https:\/\/doi.org\/10.2106\/JBJS.K.01122","journal-title":"J Bone Joint Surg Am"},{"key":"4423_CR43","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1007\/s00113-018-0508-5","volume":"121","author":"S Rammelt","year":"2018","unstructured":"Rammelt S, Manke E (2018) Syndesmosenverletzungen. Unfallchirurg 121:693\u2013703. https:\/\/doi.org\/10.1007\/s00113-018-0508-5","journal-title":"Unfallchirurg"},{"key":"4423_CR44","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1177\/1938640016685153","volume":"10","author":"KC Walley","year":"2017","unstructured":"Walley KC, Hofmann KJ, Velasco BT, Kwon JY (2017) Removal of hardware after syndesmotic screw fixation: a systematic literature review. Foot Ankle Spec 10:252\u2013257. https:\/\/doi.org\/10.1177\/1938640016685153","journal-title":"Foot Ankle Spec"},{"key":"4423_CR45","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1302\/0301-620X.98B11.BJJ-2016-0202.R1","volume":"98","author":"SA Dingemans","year":"2016","unstructured":"Dingemans SA, Rammelt S, White TO et al (2016) Should syndesmotic screws be removed after surgical fixation of unstable ankle fractures? A systematic review. Bone Joint J 98:1497\u20131504. https:\/\/doi.org\/10.1302\/0301-620X.98B11.BJJ-2016-0202.R1","journal-title":"Bone Joint J"},{"key":"4423_CR46","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.foot.2015.03.001","volume":"25","author":"TAJ Lalli","year":"2015","unstructured":"Lalli TAJ, Matthews LJ, Hanselman AE et al (2015) Economic impact of syndesmosis hardware removal. Foot (Edinb) 25:131\u2013133. https:\/\/doi.org\/10.1016\/j.foot.2015.03.001","journal-title":"Foot (Edinb)"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04423-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-022-04423-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04423-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T18:06:02Z","timestamp":1679421962000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-022-04423-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,11]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["4423"],"URL":"https:\/\/doi.org\/10.1007\/s00402-022-04423-3","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,11]]},"assertion":[{"value":"6 October 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 March 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 April 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that there are no conflicts of interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study is a voluntary survey among medical professionals so no ethical approval was necessary.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}