Bimalleolar Ankle Fracture: A Simple Fracture?

Abstract

Objective: To evaluate the frequency of deltoid ligament injury in bimalleolar supination-external rotation type fractures and whether there is a correlation between the size of the fractured medial malleolus and deltoid ligament injury . Methods: Twenty six consecutive patients underwent magnetic resonance exams after clinical and radiographic diagnosis of bimalleolar supination-external rotation type ankle fractures . Results: Thirteen patients (50%) presented deltoid ligament injury associated to bimalleolar ankle fracture. Partial injury was present in seven (26.9%) patients and total injury in six (23.1%). Regarding medial fragment size, the average was 2.88 cm in the absence of deltoid ligament injury. Partial injuries presented 1.93 cm and total 2.1 cm on average . Conclusion: Deltoid ligament injury was present in 50% of bimalleolar ankle fractures. Smaller medial malleolus fragments, especially concerning the anterior colliculus, presented greater association with partial deltoid ligament injuries. Level of Evidence IV, Cross Sectional Study.

Medial insufficiency in postoperative weight-bearing radiographs in supination-external rotation type 4 bimalleolar ankle fractures: is the Lauge-Hansen classification insufficient in predicting medial soft tissue damage?

“…They reported that the deltoid ligament was injured in 50% of cases with SER bimalleolar fractures, and there was a relationship between small fragments associated with anterior colliculus and deltoid ligament injury. There was no difference in the size of fragment between the medial malleolar fractures with fully ruptured deltoid and those with intact deltoid [8]. However, in this study, the evaluation was made only based on MR findings.…”

“…However, these studies suggested that the deltoid ligament is not damaged in fractures of the supracollicular region. Even, this injury was associated with anterior collicular fractures [7,8]. Bozscyk et al [9] suggested that many fibular fractures traditionally recognized as supination injuries actually can be caused by a pronation mechanism.…”

“…And, this was associated with a small medial malleolar fragment fracture, and it was suggested that supracollicular fractures had no deltoid ligament injury [7]. Fukuyama et al [8] evaluated the deltoid damage using MR images based on the same study. They reported that the deltoid ligament was injured in 50% of cases with SER bimalleolar fractures, and there was a relationship between small fragments associated with anterior colliculus and deltoid ligament injury.…”

“…e-ISSN: The purpose of ankle fracture treatment is to correct tibiotalar joint congruity and stability; thus, identifying ligament injuries in the formation of an ankle fracture is critical for treatment decisions [4]. In the literature, there are findings suggesting that in SER type 4 bimalleolar fractures, a medial malleolar fracture may be accompanied by a deltoid ligament injury [5][6][7][8]. However, these studies reported this either as a MRI finding or associated it with small fragment fractures at the collicular level at which the deltoid ligament is attached [5][6][7][8].…”

“…In the literature, there are findings suggesting that in SER type 4 bimalleolar fractures, a medial malleolar fracture may be accompanied by a deltoid ligament injury [5][6][7][8]. However, these studies reported this either as a MRI finding or associated it with small fragment fractures at the collicular level at which the deltoid ligament is attached [5][6][7][8].…”