EFFECTIVENESS OF SURGERY IN TREATMENT OF ANKLE FRACTURES ASSOCIATED WITH DELTOID LIGAMENT INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGHaipeng , GUZhengrong , LIUYunji , XUJing , YANJiahua , ZHANGJionghao ,  PENGCheng

Department of Orthopaedics, Jing'an District Centre Hospital, Jing'an Branch, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China;

Corresponding author：

PENGCheng, Email: pengcheng1111@126.com

Keywords：

Ankle fracture; Deltoid ligament injury; Internal fixation; Ligament repair

DOI：

10.7507/1002-1892.20150090

Video：

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Objective To evaluate the effectiveness of repairing the deltoid ligament with ankle fracture. Methods Between January 2010 and January 2013, 11 patients with ankle fractures associated with deltoid ligament injury were treated. There were 7 males and 4 females, with an average age of 38.2 years (range, 18-72 years). The interval between injury and operation was 6 hours to 7 days (mean, 4 days). According to Lauge-Hansen classification, ankle fracture was rated as pronation-external rotation type in 5 cases, as supination-external rotation type in 4 cases, and as pronation-abduction type in 2 cases. The MRI and color Doppler ultrasound showed deltoid ligament rupture. The results of valgus stress test, talus valgus tilt test, and anterior drawer test after anesthesia were all positive. Fracture was treated by open reduction and internal fixation, and deltoid injury was repaired. Results All incisions healed primarily. All patients were followed up 12-18 months (mean, 13.3 months). The X-ray films showed anatomical reduction, good position of internal fixation and stable distal tibiofibular syndesmosis. The mean fracture union time was 7.6 weeks (range, 6-8 weeks). MRI at 3 months after operation showed normal shape of the deltoid ligament. According to American Orthopaedic Foot and Ankle Society (AOFAS) score, the results were excellent in 6 cases, good in 3 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 81.8%. Conclusion It is an effective method to treat ankle fracture with deltoid ligament injury by open reduction and internal fixation of ankle fracture and repair of the deltoid ligament injury, which can effectively rebuild medial instability and has satisfactory effectiveness.

Citation： WANGHaipeng, GUZhengrong, LIUYunji, XUJing, YANJiahua, ZHANGJionghao, PENGCheng. EFFECTIVENESS OF SURGERY IN TREATMENT OF ANKLE FRACTURES ASSOCIATED WITH DELTOID LIGAMENT INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 416-419. doi: 10.7507/1002-1892.20150090 Copy

1.	Waterman BR, Belmont PJ Jr, Cameron KL, et al. Risk factors for syndesmotic and medial ankle sprain:role of sex, spor, and level of competition. Am J Sports Med, 2011, 39(5):992-998.
2.	Hintermann B, Boss A, Schäfer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med, 2002, 30(3):402-409.
3.	Tornetta P 3rd. Competence of the deltoid ligament in bimalleolar ankle fractures after medial malleolar fixation. J Bone Joint Surg Am, 2000, 82(6):843-848.
4.	Hintermann B, Knuoo M, Pagenstert GI. Deltoid ligament injuries:diagnosis and treatment. Foot and Ankle Clinics of North America, 2006, 11(3):625-637.
5.	张程, 林光锚, 刘敏. 踝关节三角韧带损伤的诊断和治疗进展. 中国骨伤, 2012, 25(11):967-970.
6.	Boss AP, Hintermann B. Anatomical study of the medial ankle ligament complex. Foot Ankle Int, 2002, 23(6):547-553.
7.	Watanabe K, Kitaoka HB, Berglund LJ, et al. The role of ankle ligaments and articular geometry in stabilizing the ankle. Clin Biomech (Bristol, Avon), 2012, 27(2):189-195.
8.	Hintermann B, Sommer C, Nigg BM. Influence of ligament transection on tibial and calcaneal rotation with loading and dorsi-plantarflexion. Foot Ankle Int, 1995, 16(9):567-571.
9.	Rasmussen O, Kromann AC, Boe S. Deltoid ligament:Functional analysis of the medial collateral ligamentous apparatus of the ankle joint. Acta Orthop Scand, 1983, 54(1):36-44.
10.	Sproule JA, Khalid M, O'Sullivan M, et al. Outcome after surgery for Maissonneuve fracture of the fibula. Injury, 2004, 35(8):791-798.
11.	Ferran NA, Oliva F, Maffulli N. Ankle instability. Sports Med Arthrosc Rev, 2009, 17(2):139-145.
12.	Hoshino CM, Nomoto EK, Norheim EP, et al. Correlation of weight bearing radiographs of stress positire ankle fractures. Foot Ankle Int, 2012, 33(2):92-98.
13.	Guo X, Ni B, Wang M, et al. Bilateral atlas laminar hook combined with transarticular screw fixation for an unstable bursting atlantal fracture. Arch Orthop Trauma Surg, 2009, 129(9):1203-1209.
14.	Yu JS, Cody ME. A template approach for detecting fractures in adults sustaining low-energy ankle trauma. Emerg Radiol, 2009, 16(4):309-318.
15.	Yu GR, Zhang MZ, Aiyer A, et al. Repair of the acute deltoid ligament complex rupture associated with ankle fractures:a multicenter clinical study. J Foot Ankle Surg, 2015, 54(2):198-202.
16.	Pai VS. Medial malleolar fracture associated with deltoid ligament rupture. J Foot Ankle Surg, 1999, 38(6):420-422.
17.	李凡, 方煌, 勘武生. 踝关节骨折伴下胫腓联合分离的手术治疗及临床意义. 中国骨与关节损伤杂志, 2008, 23(7):545-548.
18.	何河北, 董伟强, 孙永建, 等. 修复三角韧带与不修复对于踝关节骨折合并三角韧带损伤术效果的Meta分析. 中华关节外科杂志(电子版), 2014, 8(4):497-501.

1. Waterman BR, Belmont PJ Jr, Cameron KL, et al. Risk factors for syndesmotic and medial ankle sprain:role of sex, spor, and level of competition. Am J Sports Med, 2011, 39(5):992-998.
2. Hintermann B, Boss A, Schäfer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med, 2002, 30(3):402-409.
3. Tornetta P 3rd. Competence of the deltoid ligament in bimalleolar ankle fractures after medial malleolar fixation. J Bone Joint Surg Am, 2000, 82(6):843-848.
4. Hintermann B, Knuoo M, Pagenstert GI. Deltoid ligament injuries:diagnosis and treatment. Foot and Ankle Clinics of North America, 2006, 11(3):625-637.
5. 张程, 林光锚, 刘敏. 踝关节三角韧带损伤的诊断和治疗进展. 中国骨伤, 2012, 25(11):967-970.
6. Boss AP, Hintermann B. Anatomical study of the medial ankle ligament complex. Foot Ankle Int, 2002, 23(6):547-553.
7. Watanabe K, Kitaoka HB, Berglund LJ, et al. The role of ankle ligaments and articular geometry in stabilizing the ankle. Clin Biomech (Bristol, Avon), 2012, 27(2):189-195.
8. Hintermann B, Sommer C, Nigg BM. Influence of ligament transection on tibial and calcaneal rotation with loading and dorsi-plantarflexion. Foot Ankle Int, 1995, 16(9):567-571.
9. Rasmussen O, Kromann AC, Boe S. Deltoid ligament:Functional analysis of the medial collateral ligamentous apparatus of the ankle joint. Acta Orthop Scand, 1983, 54(1):36-44.
10. Sproule JA, Khalid M, O'Sullivan M, et al. Outcome after surgery for Maissonneuve fracture of the fibula. Injury, 2004, 35(8):791-798.
11. Ferran NA, Oliva F, Maffulli N. Ankle instability. Sports Med Arthrosc Rev, 2009, 17(2):139-145.
12. Hoshino CM, Nomoto EK, Norheim EP, et al. Correlation of weight bearing radiographs of stress positire ankle fractures. Foot Ankle Int, 2012, 33(2):92-98.
13. Guo X, Ni B, Wang M, et al. Bilateral atlas laminar hook combined with transarticular screw fixation for an unstable bursting atlantal fracture. Arch Orthop Trauma Surg, 2009, 129(9):1203-1209.
14. Yu JS, Cody ME. A template approach for detecting fractures in adults sustaining low-energy ankle trauma. Emerg Radiol, 2009, 16(4):309-318.
15. Yu GR, Zhang MZ, Aiyer A, et al. Repair of the acute deltoid ligament complex rupture associated with ankle fractures:a multicenter clinical study. J Foot Ankle Surg, 2015, 54(2):198-202.
16. Pai VS. Medial malleolar fracture associated with deltoid ligament rupture. J Foot Ankle Surg, 1999, 38(6):420-422.
17. 李凡, 方煌, 勘武生. 踝关节骨折伴下胫腓联合分离的手术治疗及临床意义. 中国骨与关节损伤杂志, 2008, 23(7):545-548.
18. 何河北, 董伟强, 孙永建, 等. 修复三角韧带与不修复对于踝关节骨折合并三角韧带损伤术效果的Meta分析. 中华关节外科杂志(电子版), 2014, 8(4):497-501.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF SURGERY IN TREATMENT OF ANKLE FRACTURES ASSOCIATED WITH DELTOID LIGAMENT INJURY

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