Securing the syndesmosis suture by syndesmosis hook in extreme stress caused by long-distance running. A case report

The elastic fixation of the distal tibiofibulary syndesmosis by means of Engelbrecht's hook allows weight bearing and free dorsal flexion. The example of an 40-year-old long distance runner (and surgeon) shows that this system can endure extreme stress: during the 9 months until the metal was removed, he took part in 14 contests with excellent results. He ran at least 100 km per week, together more than 3700 and classical marathons, 100 km runs and mountain marathons. When the metal was removed there was no sign of metallotic changes of the tissue at the interface between hook and plate.