Presentation
Previous motor vehicle accident. Injured right ankle. Post-open reduction and internal fixation.
Patient Data
Cortical buttress plates fixating the right lateral and medial malleoli with multiple horizontal, cannulated, fully threaded, bi-cortical screws. There are intact prostheses and no abnormal periprosthetic lucency. There is remodeling with no persistent fracture lines.
There is "kissing" ossification of the distal tibiofibular syndesmosis.
There is mild bi-malleolar soft tissue swelling.
Case Discussion
Distal tibiofibular syndesmotic heterotopic ossification (TFSO) is usually due to previous trauma and syndesmotic sprain. In a patient with open reduction and internal fixation, the surgical management of the fractures may also initiate ossification.
in cases of unilateral ossification, surface osteogenic sarcoma (a rare but possible site) must always be excluded.
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