Deltoid Ligament Reconstruction in Lateral Malleolus Fractures with Deltoid Rupture

Abstract

Background: Treatment of lateral malleolus fractures is a controversial issue, especially when is associated with deltoid ligament (DL) rupture Objectives: In the present study, the effect of DL repair in patients with lateral malleolar fractures with deltoid rupture was investigated on medial clear space (MCS), ankle-hindfoot score (AHS), and malreduction rates. Methods: 65 patients who referred with lateral malleolus fracture plus DL rupture during 2017-2018 and underwent surgery were studied. The diagnosis was conducted by a single renowned orthopedic surgeon according to physical examination, clinical, and paraclinical findings such as radiography. A questionnaire was used to record  demographic information, pain severity, duration of follow-up, AO classification, pre- and postoperative MCS, AHS, and malreduction and data of the patients with and without DL reconstruction were compared using SPSS software (version 21). Results: About half of the patients (51%) were men. DL was reconstructed in 50.8% of the patients. AO category of the most (53.8%) of the patients was class-B. There was no difference between the patients with and without DL reconstruction in the frequency of fibular malreduction, mean pain severity, and AHS (P>0.05). Mean MCS was neither different between the groups before (P=0.946), nor after surgery (P=0.794). Mean change in MCS score was -2.03±0.95 and -1.94±0.95 in the groups with and without DL reconstruction, respectively (P=0.606). Conclusion: This study showed that DL reconstruction did not affect the medial clearance space. Further studies are required on stability and biomechanics to determine which injuries need surgery and which ones need conservative treatment.