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Deltoid ligament augmentation replacing syndesmotic fixation for the treatment of ankle fractures: a prospective
Ting Li1, Zhijian Sun1, Xu Sun1
1Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035 China.
Objectives:
The ankle fracture with both deltoid ligament (DL) rupture and syndesmotic diastasis was treated by fixing syndesmosis after open reduction and plate fixation of the fibular fracture. The present study aimed to evaluate the effect of deltoid ligament augmentation (DLA) replacing syndesmosis fixation for the treatment of such a fracture.
Methods:
This randomized controlled trial recruited acute ankle fracture patients with syndesmotic instability and DL rupture. Patients were randomized into DLA and trans-syndesmotic screw fixation (TSSF) groups. The primary outcome measure was the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale at 1 year post-surgery. The secondary outcome measures included Philips and Schwartz clinical scoring system of the ankle, the short-form (SF-36) questionnaire for quality of life, the range of ankle motion, the time to partial weight-bearing, the time to full weight-bearing, the time to return to previous work, the time to preinjury-level play, radiographic parameters, and complications. The analyses followed the intention-to-treat principle.
Results:
A total of 60 patients were randomized, and 59 were included for analysis: 30 in the DLA group and 29 in the TSSF group. The AOFAS scores at 1 year after surgery showed no statistical significance between the two groups. However, clinical scores at 3 months after surgery, including AOFAS score, Philips and Schwartz score, and subscales of SF-36 (physical function, general health, and social function), were significantly better in the DLA group than the TSSF group. Time to partial-weight-bearing, full-weight-bearing, return to work, and return to preinjury-level play were significantly reduced in the DLA group. No major complications were observed in both groups, and no difference was detected in the radiographic parameters immediately after surgery and at 1-year follow-up.
Conclusion:
DLA achieved satisfactory clinical and radiographic outcomes at 1-year follow-up with rapid recovery post-surgery. This treatment method should be considered as an alternative option in ankle fractures associated with deltoid ligament rupture and syndesmotic diastasis.
