Dossier : Lésions traumatiques de la syndesmose tibio-fibulaire distale

Conclusion

Les lésions de la syndesmose sont relativement fréquentes dans les sports de contact et notamment le judo. Beaucoup de ces traumatismes sont mal identifiés initialement. La suspicion d’une lésion de la syndesmose devant un mécanisme traumatique en rotation latérale permet d’orienter l’examen physique à la recherche d’une douleur sur le LTFAI, d’une rotation latérale douloureuse et d’un squeeze test positif. La méconnaissance du diagnostic initial est source de chronicisation des symptômes. Une fois la suspicion de lésion de la syndesmose évoquée, une analyse précise des clichés radiographiques permettra d’évaluer la stabilité ou non de la lésion et la présence ou non de fracture associée. L’IRM ou l’échographie dans des mains expertes permettra de préciser les lésions de grade II à haut risque d’instabilité. Une prise en charge au stade aigu est indispensable et sera conservatrice en fonction de la stabilité des lésions ou chirurgicale en cas d’instabilité avérée ou occulte. Le délai de traitement et de reprise des activités est plus long que pour une simple entorse du plan latéral isolé. Reste à préciser les modalités chirurgicales consensuelles et le démembrement précis lésionnel des grades II permettant de mettre en évidence des facteurs prédictifs d’instabilité occulte à long terme.

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