INTRODUCTION: During 280 years of studies of the anatomy of the distal tibiofibular articulation, there have arisen many unclear issues regarding the description of individual structures and their terminology. These historical inaccuracies were subsequently reflected in the clinical practice. MATERIALS AND METHODS: A literature search of original publications and historical sources was performed. RESULTS: The distal tibiofibular articulation is a synovial joint, rather than a syndesmosis, as it is an integral part of the ankle joint. The interosseous tibiofibular ligament (ITFL), described for the first time by a French anatomist Bichat in 1801, is the strongest ligament of the tibiofibular mortise. Unfortunately, this clinically important ligament is not recognized by the current international anatomical nomenclature. The terms anterior inferior (AITFL) and posterior inferior tibiofibular ligaments (PITFL) are historical remnants "reimported" from the American/British literature and should not be used, because the analogous superior ligaments do not exist. The intermalleolar ligament, first described by Weitbrecht in 1742, is a variable, but constant, structure reinforcing the posterior capsule of the ankle joint. The term inferior transverse ligament (IFT) denoting in the English literature the inferior part of the posterior tibiofibular ligament was originally used for the intermalleolar ligament. The IFT ligament is a part of the posterior tibiofibular ligament and there is no reason to stress its importance. CONCLUSION: The chaos in the anatomy, terminology and depiction of the articulation of the distal tibia and fibula, unparalleled in any other joint of the human body, is the result of historical development. A certain negative role was, in this respect, played also by Basiliensia Nomina Anatomica (1895), that eradicated ITFL and called the distal tibiofibular joint a syndesmosis.

• Keywords
• Ankle joint, History, Interosseous tibiofibular ligament, Tibiofibular mortise, Tibiofibular syndesmosis,
• MeSH
• History, 18th Century MeSH
• History, 19th Century MeSH
• History, 20th Century MeSH
• Fibula * anatomy & histology   MeSH
• Ankle Joint * anatomy & histology   MeSH
• Clinical Relevance MeSH
• Ligaments, Articular * anatomy & histology   MeSH
• Humans MeSH
• Terminology as Topic MeSH
• Tibia * anatomy & histology   MeSH
• Check Tag
• History, 18th Century MeSH
• History, 19th Century MeSH
• History, 20th Century MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Historical Article MeSH
• Review MeSH

Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to significantly poorer outcomes. Adequate diagnosis, classification and treatment require preoperative CT examination, preferably with 3D reconstructions. The indication for surgical treatment is made individually on the basis of comprehensive assessment of the three-dimensional outline of the PM fracture and all associated injuries to the ankle including syndesmotic instability. Anatomic fixation of the avulsed posterior tibiofibular ligament will contribute to syndesmotic stability and restore the integrity of the incisura tibiae thus facilitating anatomic reduction of the distal fibula. A necessary prerequisite is mastering of posterolateral and posteromedial approaches and the technique of direct reduction and internal fixation. Further clinical studies with higher numbers of patients treated by similar methods and evaluation of pre- and postoperative CT scans will be necessary to determine reliable prognostic factors associated with certain types of PM fractures and associated injuries to the ankle.

• Keywords
• Ankle fractures, Classification of posterior malleolar fractures, Posterior malleolus, Trimalleolar fractures,
• MeSH
• Biomechanical Phenomena physiology   MeSH
• Joint Dislocations surgery   MeSH
• Ankle Fractures diagnostic imaging   physiopathology   surgery   MeSH
• Ligaments, Articular injuries   surgery   MeSH
• Bone Wires MeSH
• Bone Screws MeSH
• Humans MeSH
• Joint Instability etiology   prevention & control   MeSH
• Tomography, X-Ray Computed MeSH
• Postoperative Complications etiology   MeSH
• Fracture Fixation, Internal instrumentation   methods   MeSH
• Treatment Outcome MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH