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Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures
Christopher R Jones1, James A Nunley
1Department of Orthopaedic Surgery, Duke University Medical Center, Duke University, Durham, NC.
Objectives:
To compare the outcomes of bimalleolar equivalent ankle fractures treated with lateral malleolus open reduction and internal fixation (ORIF) with transsyndesmotic fixation versus lateral malleolus ORIF with deltoid ligament repair.
Design:
Retrospective design.
Setting:
Single level I trauma center.
Patients/Participants:
Subjects with bimalleolar equivalent ankle fractures were eligible for enrollment. Patients with posterior or medial malleolar fractures and age <16 years were excluded. Twenty-seven total subjects met inclusion criteria. Fifteen patients were treated with lateral malleolus ORIF with transsyndesmotic fixation, whereas 12 were treated with lateral malleolus ORIF with deltoid ligament repair.
Intervention:
Lateral malleolus ORIF with transsyndesmotic fixation versus lateral malleolus ORIF with deltoid ligament repair.
Main Outcome Measurements:
Lower Extremity Function Scale, Foot and Ankle Disability Index, Short Musculoskeletal Function Assessment, Foot and Ankle Outcome Score, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, Visual Analog Pain Scale, and overall function of lower extremity.
Results:
Univariate analysis of the outcome questionnaire variables demonstrated no statistically significant differences between the 2 groups. All patients in the syndesmotic fixation group underwent a subsequent procedure for removal of the syndesmotic implant. Additionally, there were 2 complications in the syndesmotic group that required repeat operative intervention.
Conclusions:
Repairing the deltoid ligament at the time of lateral malleolus fixation demonstrates subjective, functional, and radiologic outcomes that are comparable with lateral malleolus fixation with syndesmotic fixation for bimalleolar equivalent ankle fractures. The former avoids the costs and inherits surgical risks that occur during a subsequent operation for removal of the syndesmotic implant.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
