title: Repair of the acute deltoid ligament complex rupture associated with ankle fractures: a multicenter clinical study.
abstract: Controversy exists concerning the need for operative repair of the deltoid ligament during management of acute ankle fractures. The purpose of our report was to identify the indications for surgical intervention for deltoid ligament injury in the setting of ankle fractures. Furthermore, we aimed to elucidate the clinical outcomes after deltoid ligament repair in this setting. This was a multicenter study, involving 4 clinical institutions. From January 2006 to December 2011, 1533 ankle fractures underwent surgical intervention. Of this group, 131 deltoid ligament ruptures (8.55%) were identified and repaired operatively. Of the 131 patients, 74 were male (56.5%) and 57 were female (43.5%), with a mean age of 33.2 (range 16 to 63) years. The outcome measures included the clinical examination findings, radiographic findings, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, visual analog scale (VAS) scores, and Medical Outcomes Study Short Form 36-item questionnaire scores. All incisions healed primarily. A total of 106 patients were followed up for a minimum of 12 (range 12 to 72) months, with an average follow-up period of 27 months. The mean interval to fracture union was 14.5 (range 9 to 16) weeks. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score at the latest follow-up visit was 91.4 (range 83 to 100) points. The mean visual analog scale score was 1.2 (range 0 to 6) points. The mean Short Form-36 score was 91.2 (range 80 to 96) points. Compared with the preoperative scores, all the 3 outcome measures had improved significantly postoperatively (p < .05). The postoperative stress radiographs did not reveal any ankle instability. None had evidence of post-traumatic arthritis of the ankle from the clinical examination and radiographs. A reasonable clinical evaluation and surgical repair was executed, with an appropriate repair technique chosen according to the site of deltoid ligament rupture. The results of the present multicenter study have shown that deltoid ligament rupture can be repaired in patients with an unstable medial ankle after fracture fixation and prevent ankle stabilization-related complications.
authors.affiliation: Orthopedist, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: yuguangrong@hotmail.com.
authors.forename: Guang-rong
authors.initials: GR
authors.lastname: Yu
authors.affiliation: Orthopedist, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: michaelzhang120@hotmail.com.
authors.forename: Ming-zhu
authors.initials: MZ
authors.lastname: Zhang
authors.affiliation: Orthopedist, Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD.
authors.forename: Amiethab
authors.initials: A
authors.lastname: Aiyer
authors.affiliation: Orthopedist, Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Tang
authors.affiliation: Orthopedist, Department of Orthopaedics, Pu Ai Hospital of Huazhong Technology and Science University, Wuhan, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Xie
authors.affiliation: Orthopedist, Department of Orthopaedics, Hangzhou Xiaoshan Hospital, Hangzhou, China.
authors.forename: Lin-ru
authors.initials: LR
authors.lastname: Zeng
authors.affiliation: Orthopedist, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: You-guang
authors.initials: YG
authors.lastname: Zhao
authors.affiliation: Orthopedist, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Orthopedist, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yun-feng
authors.initials: YF
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D064386:Ankle Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016512:Ankle Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012421:Rupture; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult
keywords: ankle; fibula; fracture union; ligament; surgery; tibia