Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair.

Background: There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair.

Methods: This was a single-center retrospective study involving 13 surgeons. Inclusion criteria were patients aged 18 years or older who underwent open fixation for a supination external rotation type IV (SER IV) equivalent ankle fracture. SER IV fractures were confirmed with stress radiographs. Deltoid injury was confirmed with an intraoperative external rotation stress test. A total of 146 patients were included. Eighty patients received a deltoid repair (DR), and 66 patients did not receive a deltoid repair (NDR). Patient-reported outcomes via PROMIS scores were collected preoperatively and at least 1 year postoperatively for all patients. Preoperative and postoperative medial clear space (MCS) were reviewed for all patients.

Results: There were no significant differences in preoperative and postoperative PROMIS domains between the 2 cohorts. There were also no significant differences in preoperative MCS and postoperative MCS between the 2 cohorts. There were no significant differences in the incidence of subsequent procedures for removal of painful hardware, revisions, infections, progression to arthritis, and persistent pain.

Conclusion: This study compares short- to medium-term outcomes and complications of SER IV-equivalent ankle fractures with and without deltoid repair. No significant differences between PROMIS scores, postoperative MCS, and complication rates were observed between groups.

Level of evidence: Level III, retrospective case control study.