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Deltoid All-Inside Repair in SER IV Bimalleolar-Equivalent Ankle Fractures
Tiago Soares Baumfeld1, Matheus Kuffner1, Daniel Soares Baumfeld2
1From Hospital Felício Rocho, Belo Horizonte, Brazil.
Foot & Ankle Specialist
|April 12, 2026
Summary
This study shows that arthroscopic all-inside deltoid repair effectively stabilizes supination-external rotation stage IV ankle fractures. The technique provides good short-term functional and radiographic outcomes, preserving joint alignment and ligament integrity.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Traumatology
Background:
- Ankle fractures are common lower limb injuries.
- Supination-external rotation (SER) stage 4 injuries involve disruption of the medial malleolus or deltoid ligament.
- Deltoid ligament stability is crucial for ankle function, but surgical repair necessity is debated.
Purpose of the Study:
- To evaluate the effectiveness of an all-inside repair technique for the deltoid ligament in SER stage 4 ankle fractures.
- To assess the short-term radiographic and functional stability following this repair method.
Main Methods:
- A prospective case series of 12 patients with SER stage 4 ankle fractures and unstable deltoid ligament injuries.
- All patients underwent deltoid all-inside repair concurrently with fracture fixation.
- Outcomes assessed via VAS, AOFAS scores, and stress/weight-bearing radiographs measuring talar tilt (TT) and medial clear space (MCS).
Main Results:
- Patients reported good functional outcomes with a mean VAS of 1.5 and AOFAS score of 87 at 6 months.
- No complications were observed during the study period.
- Radiographic stability was maintained, with consistent MCS and TT measurements under various conditions, confirming preserved joint alignment and ligament integrity.
Conclusions:
- Arthroscopic all-inside deltoid repair is a viable technique for SER IV bimalleolar-equivalent ankle fractures.
- This method demonstrates favorable short-term functional outcomes and radiographic stability.
- The technique effectively maintains reduction and ligament integrity post-surgery.
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