Assessing the Utility of Deltoid Ligament Repair in Ankle Fracture: A Systematic Review

Abstract

Ankle fractures are common injuries treated by orthopedists. Indications for operative repair of deltoid ligament (DL) injuries in ankle fracture patients are debated. The purpose of this review is to determine the indications for operative DL repair.Ovid MEDLINE, CINAHL, and Scopus were searched up to December 2019. Web of Science was searched up to August 2018. Search terms included "Deltoid" and "Ligament" or "Ligaments." Comparative studies assessing conservative vs operative DL repair were searched for. Articles meeting inclusion criteria were screened in two stages to determine eligibility.Out of 1,542 articles, nine were included in our qualitative synthesis. These nine studies included 449 patients, of which 233 were treated with open reduction internal fixation (ORIF) with or without transsyndesmotic (TS) screw fixation, and 205 of which were treated with ORIF with DL repair. The remaining 21 patients were managed nonoperatively, had no evidence of DL injury, or were lost to follow-up.There is a lower rate of malreduction associated with DL repair compared to TS screw fixation. Moreover, DL repair may be useful in treating patients with Weber Type C fractures, concomitant DL-syndesmotic disruption, or residual valgus instability following ORIF in isolated lateral malleolar fractures.

Kirschner Wire Internal Fixation of the Medial Tibiotalar Joint for Indirect Repair of Deltoid Ligament Injury: A Retrospective Comparative Study

“…The deep layer of the deltoid ligament includes the deep anterior and posterior tibiotalar ligaments, which prevent external rotation of the talus 20,21 . Currently, the optimal repair strategy for the deltoid ligament is controversial 9 . Many researchers have found through in vitro mechanical tests that cutting the deep deltoid ligament significantly changes the stability of the ankle joint in all directions 22–24 .…”

“… 20 , 21 Currently, the optimal repair strategy for the deltoid ligament is controversial. 9 Many researchers have found through in vitro mechanical tests that cutting the deep deltoid ligament significantly changes the stability of the ankle joint in all directions. 22 , 23 , 24 If the deep deltoid ligament is kept intact and the superficial ligament, lateral collateral ligament, or compound lateral malleolus fractures are completely cut off, the talus does not shift or tilt significantly under stress.…”

“…5,7,8 Currently, whether deltoid ligament injuries require surgical repair of ankle fractures remains controversial. 9 Scholars who support non-repair of the deltoid ligament believe that most deltoid ligament injuries can heal with only conservative treatment. 10 They believed that the deep anatomical position of the deltoid ligament was too deep to be exposed during surgery.…”

“…Currently, whether deltoid ligament injuries require surgical repair of ankle fractures remains controversial. 9 Scholars who support non‐repair of the deltoid ligament believe that most deltoid ligament injuries can heal with only conservative treatment. 10 They believed that the deep anatomical position of the deltoid ligament was too deep to be exposed during surgery.…”