Internal tibial torsion is related to syndesmosis injury in a large osteological collection

•Increased internal torsion in syndesmosis injury vs. controls (6.2 vs. 7.9 degrees).•Syndesmosis injury presence trended toward increased internal torsion (P = 0.059).•Internal torsion group had increased syndesmosis injury vs. external torsion (P = 0.035).•Torsion across sex, race, and laterality consistent with previous literature.•Increased internal torsion in males, African Americans, and left tibiae. The long-term consequences of tibial torsion remain unclear. This study evaluated whether syndesmotic injuries are associated with tibial torsion. A collection of over 3000 cadaveric skeletons was screened for irregular bony prominence along the lateral distal tibia, consistent with previous syndesmosis injury. Tibial torsion was measured and compared to 1034 control cadaveric tibiae. Mean torsion of 236 specimens with syndesmotic injury was 6.2±8.9 degrees, while that of control specimens was 7.9±8.8 degrees (P = 0.008). Multiple regression analysis showed a non-statistically significant trend toward internal torsion and syndesmotic injury (standardized beta=−0.051, P=0.059). Syndesmosis injury was present in 48/200 specimens (24.0%) with internal torsion and 31/199 specimens (15.6%) with external torsion (P=0.035). This association between internal tibial torsion and syndesmotic injury suggests that internal tibial torsion might not be an entirely benign condition and merits further study.