The authors have analysed clinical and radiographic results in 39 cases of the ankle fractures combined with distal tibiofibular diastasis to evaluate the need for surgical repair of the ruptured deltoid ligament.

All of the cases were treated with open reduction and rigid internal fixation for fracture of the distal fibula and trans-syndesmotic screw fixation for the distal tibiofibular diastasis, but ruptured deltoid ligament were treated with surgical or non-surgical methods. The patients were divided into two groups retrospectively. Group I included 24 ankle fractures that were treated with surgical repair for the ruptured deltoid ligament. Group II included 15 patients who were treated conservatively for the ruptured deltoid ligament.

The clinical results were excellent in 16 (66.6%), good in 5 (20.8%) in group I, and excellent in 10 (66.6%) and good in 3 (20%) in group II. The radiographic results in reduction of medial joint space were good in 20 (83.3%), fair in 2 (8.3%) in group I, and good in 12 (80%) and fair in 2 (13.3%) in group II at last follow up.

The ruptured deltoid ligament can be treated conservatively if the lateral malleolar fracture and the distal tibiofibular diastasis are stabilized anatomically and the medial joint space is reduced satisfactorily.