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Abstract
Purpose
To evaluate the necessity for repair of associated deltoid ligament rupture in lateral malleolar fracture.
Materials and Methods
Twenty of twenty-five patients were evaluated. Each received surgical treatment without repair of the ruptured deltoid ligament. We found that the medial clear space was widened more than 5 mm in intraoperative stress tests which had been done between May 2003 and June 2008. We did follow-up on these patients for more than 1 year after surgery. At the final follow-up, radiologic and clinical assessment were evaluated on plain X-ray and according to Olerud Molander ankle scores.
Results
Open reduction and internal fixation of the lateral malleolar was done in all cases and an additional transfixation screw was needed in 17 patients who had concurrent syndesmotic disruption. Average medial clear space widening before surgery was 9.28 mm (7.0-17.14 mm), at final follow-up time it was 3.43 mm (2.9-5.28 mm). And there were 8 (40%) good, 10 (50%) fair and 2 (10%) poor ratings on radiologic evaluation, but the mean clinical score was 93.75, with 17 (85%) being excellent, 2 (10%) good and 1 (5%) fair on clinical evaluation.
Conclusion
In the treatment of lateral malleolus fracture associated with disruption of the deltoid ligament, satisfactory clinical results could be obtained including lateral joint stability, with accurate anatomical reduction and internal fixation of the lateral malleolus and distal tibio-fibular joints. Medial joint stability could be obtained without deltoid ligament repair.
Figures and Tables
Figure 1
Manual stress test under anesthesia shows that medial clear space has widened on fluoroscopy.
Figure 2
Intraoperative stress test before application of the syndesmotic screw confirmed the diastasis.
Figure 3
Probe is inserted to medial joint space for realignment of the deltoid ligament through a minimal skin incision at the joint line just medial to the anteriot tibial tendon.
Figure 4
A patient with SER type IV ankle fracture, associated with disruption of deltoid ligament, was injured during soccer. (A) Preoperative radiograph shows lateral malleolar fracture with medial clear space widening, 7.3 mm. (B) Postoperative radiograph shows reduced ankle joint fixed by one-third plate and screws and additional transfixation screw for reduction of distal tibio-fibular joint. (C) After removal of the implants at postoperative 15 months, no recurrence of medial clear space widening is seen on the radiograph.
Figure 5
At the final follow-up, range of motion of the ankle joint was 40° in plantar flexion, 20° in dorsiflexion.
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