CT-based morphologic variation of the distal tibiofibular syndesmosis: influence of age and sex.

Abstract

The distal tibiofibular syndesmosis plays a critical role in ankle stability and its anatomical variations may influence the diagnosis and management of syndesmotic injuries.However,the extent to which these variations are affected by age and sex remains unclear. To evaluate age- and sex-related morphological variations of the distal tibiofibular syndesmosis and their potential clinical implications. Retrospective study. A total of 110 patients (65 males-45 females) presenting with ankle fractures between 2024 and 2025 who had appropriate bilateral CT imaging were retrospectively analyzed.Measurements included ATFI,LI,DI,ATFCS,PTFCS,FW, and TSA.Data were compared across age groups (0-20,20-40,40-60 and 60-80 years) and sex. Significant differences were observed in PTFCS (p =0.001) and TSA (p =0.039) among age groups.Younger patients had higher PTFCS values, whereas older patients (60-80 years) exhibited greater TSA.In sex-based comparisons, males had significantly higher PTFCS (p =0.011) and LI (p<0.001) than females.Although FW was higher in males,the difference was not statistically significant (p =0.050).No significant sex differences were found in ATFCS,ATFI,DI or TSA. The morphology of the distal tibiofibular syndesmosis demonstrates significant variations according to age and sex.This finding suggests that commonly used diagnostic parameters and reference values may not be universally applicable to all patients.Therefore, individual anatomical variations should be carefully considered in the diagnosis and surgical management of syndesmotic injuries.Furthermore, this morphologic variability may influence intraoperative assessment and supports a more individualized, anatomy-based approach to surgical planning.