Effect of Deltoid Ligament Repair on Syndesmotic Stabilization in Patients with Ankle Fractures
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Purpose: This study aimed to evaluate the effectiveness of deltoid ligament repair on syndesmotic stabilization in patients with acute ankle fractures with ruptured deltoid and syndesmotic ligaments. Materials and Methods: The medical records of 41 patients (41 ankles) who underwent surgery for Weber type B ankle fracture with ruptured deltoid and syndesmotic ligaments were retrospectively analyzed. The mean follow-up duration was 36 months (range 18~65 months). Patients were divided into two groups: those that underwent deltoid ligament repair (the deltoid group) and those who did not (the non-deltoid group). Both groups were also divided into two subgroups, namely, the D1/S1 group, which underwent syndesmotic screw fixation, or the D2/S2 group, which did not. Medial clear space (MCS), tibiofibular clear space (TFCS), anterior fibular line (AFL) ratio, and posterior fibular line (PFL) distance were measured, and visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Foot Function Index (FFI) scores were evaluated. Results: TFCS changed significantly after surgery in the D2 and S1 groups (p=0.01, p=0.03, respectively). Subgroup MCSs, TFCSs, and AFL ratios were not significantly altered by surgery in the four subgroups (p=0.82, p=0.45, p=0.25, respectively). However, postoperative PFL distances were significantly different in the D2 and S1 groups and the S1 and S2 groups (p=0.02, p=0.02, respectively). Mean TFCS decreased significantly after surgery in the D2 and S1 groups. The postoperative VAS, AOFAS scores, and FFI were not significantly dif- ferent between the subgroups (p=0.44, p=0.40, and p=0.46, respectively). Conclusion: Deltoid ligament repair seemed to restore ankle stability without addressing syndesmosis in Weber type B ankle fractures with rupture of deltoid and syndesmotic ligaments.
Abstract
Purpose: This study aimed to evaluate the effectiveness of deltoid ligament repair on syndesmotic stabilization in patients with acute ankle fractures with ruptured deltoid and syndesmotic ligaments. Materials and Methods: The medical records of 41 patients (41 ankles) who underwent surgery for Weber type B ankle fracture with ruptured deltoid and syndesmotic ligaments were retrospectively analyzed. The mean follow-up duration was 36 months (range 18~65 months). Patients were divided into two groups: those that underwent deltoid ligament repair (the deltoid group) and those who did not (the non-deltoid group). Both groups were also divided into two subgroups, namely, the D1/S1 group, which underwent syndesmotic screw fixation, or the D2/S2 group, which did not. Medial clear space (MCS), tibiofibular clear space (TFCS), anterior fibular line (AFL) ratio, and posterior fibular line (PFL) distance were measured, and visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Foot Function Index (FFI) scores were evaluated. Results: TFCS changed significantly after surgery in the D2 and S1 groups (p=0.01, p=0.03, respectively). Subgroup MCSs, TFCSs, and AFL ratios were not significantly altered by surgery in the four subgroups (p=0.82, p=0.45, p=0.25, respectively). However, postoperative PFL distances were significantly different in the D2 and S1 groups and the S1 and S2 groups (p=0.02, p=0.02, respectively). Mean TFCS decreased significantly after surgery in the D2 and S1 groups. The postoperative VAS, AOFAS scores, and FFI were not significantly dif- ferent between the subgroups (p=0.44, p=0.40, and p=0.46, respectively). Conclusion: Deltoid ligament repair seemed to restore ankle stability without addressing syndesmosis in Weber type B ankle fractures with rupture of deltoid and syndesmotic ligaments.
참고문헌 (29)
- Min Sun Jeong, "Deltoid ligament in acute ankle injury: MR imaging analysis", Skeletal Radiology, 43(5), pp.655~663 (2014), Springer Science and Business Media LLC[DOI]
- Paul Tornetta, "Treatment of the stress positive ligamentous SE4 ankle fracture: incidence of syndesmotic injury and clinical decision making", Journal of Orthopaedic Trauma, 26(11), pp.659~661 (2012), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Tony Brosky, "The Ankle Ligaments: Consideration of Syndesmotic Injury and Implications for Rehabilitation", J Orthop Sports Phys Ther, 21(4), pp.197~205 (1995), Journal of Orthopaedic & Sports Physical Therapy (JOSPT)[DOI]
- HR Chissell, "The influence of a diastasis screw on the outcome of Weber type-C ankle fractures", The Journal of Bone and Joint Surgery. British volume, 77-B(3), pp.435~438 (1995), British Editorial Society of Bone & Joint Surgery[DOI]
- J. G. Kennedy, "Evaluation of the Syndesmotic Screw in Low Weber C Ankle Fractures", Journal of Orthopaedic Trauma, 14(5), pp.359~366 (2000), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Christopher R. Jones, "Deltoid Ligament Repair Versus Syndesmotic Fixation in Bimalleolar Equivalent Ankle Fractures", Journal of Orthopaedic Trauma, 29(5), pp.245~249 (2015), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Seung Hun Woo, "Short-Term Results of a Ruptured Deltoid Ligament Repair During an Acute Ankle Fracture Fixation", Foot Ankle Int, 39(1), pp.35~45 (2017), SAGE Publications[DOI]
- James D. Michelson, "Diagnosing deltoid injury in ankle fractures: the gravity stress view", Clinical Orthopaedics and Related Research, 387, pp.178~182 (2001), Ovid Technologies (Wolters Kluwer Health)[DOI]
- H. J. Schock, "The use of gravity or manual-stress radiographs in the assessment of supination-external rotation fractures of the ankle", The Journal of Bone and Joint Surgery. British volume, 89-B(8), pp.1055~1059 (2007), British Editorial Society of Bone & Joint Surgery[DOI]
- Cotton FJ, "Dislocations and joint-fractures", Ann Surg, 80, pp.286~ (1924)
- Constantinos Louis Loizou, "Radiological assessment of ankle syndesmotic reduction", The Foot, 32, pp.39~43 (2017), Elsevier BV[DOI]
- Harold B. Kitaoka, "Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes", Foot Ankle Int, 18(3), pp.187~188 (1997), SAGE Publications[DOI]
- Elly Budiman-Mak, "The foot function index: A measure of foot pain and disability", Journal of Clinical Epidemiology, 44(6), pp.561~570 (1991), Elsevier BV[DOI]
- Mark Earll, "Contribution of the Deltoid Ligament to Ankle Joint Contact Characteristics: A Cadaver Study", Foot Ankle Int, 17(6), pp.317~324 (1996), SAGE Publications[DOI]
- Jafet Massri-Pugin, "Role of the Deltoid Ligament in Syndesmotic Instability", Foot Ankle Int, 39(5), pp.598~603 (2018), SAGE Publications[DOI]
- Kota Watanabe, "The role of ankle ligaments and articular geometry in stabilizing the ankle", Clinical Biomechanics, 27(2), pp.189~195 (2012), Elsevier BV[DOI]
- Klossner O, "Late results of operative and non-operative treatment of severe ankle fractures. A clinical study", Acta Chir Scand Suppl, Suppl 293, pp.1~93 (1962)
- Ross Feller, "Arthroscopic Quantification of Syndesmotic Instability in a Cadaveric Model", Arthroscopy: The Journal of Arthroscopic & Related Surgery, 33(2), pp.436~444 (2017), Elsevier BV[DOI]
- William C. Burns, "Tibiotalar Joint Dynamics: Indications for the Syndesmotic Screw—A Cadaver Study", Foot Ankle, 14(3), pp.153~158 (1993), SAGE Publications[DOI]
- Jafet Massri-Pugin, "Effect of Sequential Sectioning of Ligaments on Syndesmotic Instability in the Coronal Plane Evaluated Arthroscopically", Foot Ankle Int, 38(12), pp.1387~1393 (2017), SAGE Publications[DOI]
- Kwok Bill Chan, "Role of Ankle Arthroscopy in Management of Acute Ankle Fracture", Arthroscopy, 32(11), pp.2373~2380 (2016), Elsevier BV[DOI]
- H. Claude Sagi, "The Functional Consequence of Syndesmotic Joint Malreduction at a Minimum 2-Year Follow-Up", Journal of Orthopaedic Trauma, 26(7), pp.439~443 (2012), Ovid Technologies (Wolters Kluwer Health)[DOI]
- J.J Candal-Couto, "Instability of the tibio-fibular syndesmosis: have we been pulling in the wrong direction?", Injury, 35(8), pp.814~818 (2004), Elsevier BV[DOI]
- J. J. Hermans, "Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI", Skeletal Radiology, 41(7), pp.787~801 (2011), Springer Science and Business Media LLC[DOI]
- John M Schuberth, "Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments", The Journal of Foot and Ankle Surgery, 43(1), pp.20~29 (2004), Elsevier BV[DOI]
- Yvonne Cheung, "MRI of Isolated Distal Fibular Fractures with Widened Medial Clear Space on Stressed Radiographs: Which Ligaments Are Interrupted?", American Journal of Roentgenology, 192(1), pp.W7~W12 (2009), American Roentgen Ray Society[DOI]
- Michael J. Gardner, "Malreduction of the Tibiofibular Syndesmosis in Ankle Fractures", Foot Ankle Int, 27(10), pp.788~792 (2006), SAGE Publications[DOI]
- Daniel J. Song, "The effect of syndesmosis screw removal on the reduction of the distal tibiofibular joint: a prospective radiographic study", Foot Ankle Int, 35(6), pp.543~548 (2014), SAGE Publications[DOI]
- Ajay Manjoo, "Functional and Radiographic Results of Patients with Syndesmotic Screw Fixation: Implications for Screw Removal", Journal of Orthopaedic Trauma, 24(1), pp.2~6 (2010), Ovid Technologies (Wolters Kluwer Health)[DOI]
