A 25-year-old footballer lands on an externally rotated foot and develops ankle pain above the joint line. Anteroposterior radiographs show widening of the tibiofibular clear space. External rotation stress testing reproduces his pain. Which structure is injured?

• A Anterior talofibular ligament
• B Spring ligament complex
• C Calcaneofibular ligament
• D Distal tibiofibular syndesmosis ✓

Explanation

Pain above the joint line, widened tibiofibular clear space and positive external rotation or squeeze tests indicate a syndesmotic (high ankle) sprain involving the anterior inferior tibiofibular ligament and interosseous membrane. ATFL and CFL injuries follow inversion mechanisms with tenderness below the joint line and normal clear space, making them the expected distractors. The spring ligament supports the talar head medially and is unrelated to this mechanism.

Reference: DeLee and Drez's Orthopaedic Sports Medicine, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.