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There is limited evidence of superior clinical outcomes with the addition of deltoid repair compared with open reduction and internal fixation of the fibula alone. The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the deltoid ligament ruptures, a "bimalleolar equivalent" ankle fracture occurs, and the surgeon is presented with several diagnostic and therapeutic challenges. In the native ankle, the deltoid ligament provides restraint to eversion and external rotation of the talus on the tibia. In bimalleolar equivalent ankle fractures, there is often gross medial instability even after fibular reduction. Retraction of the deltoid with subsequent healing in a nonanatomic position theoretically may cause instability, persistent medial gutter pain, and loss of function with risk of early arthritis. In mild cases, deltoid injury may not be obvious, and potential diagnostic techniques include preoperative and intraoperative stress radiography, MRI, and ultrasonography. The most common injury pattern is avulsion from the medial malleolus, and most current repair techniques involve direct repair of the capsular and deltoid injuries involving suture anchors in the medial malleolus and imbrication of the superficial and deep deltoid fibers. To date, there is limited evidence of superior clinical outcomes with the addition of deltoid repair compared with open reduction and internal fixation of the fibula alone.
Ultrasound findings of the deltoid ligament in patients with acute ankle sprains: A retrospective review - ScienceDirect
Deltoid Ligament Repair in Bimalleolar Equivalent Ankle Fractures: A Technique Tip
Deltoid ligament arthroscopic repair in ankle fractures: Case series - ScienceDirect
PDF) The repair of a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Jt Surg Br
Frontiers Repair of deep deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture by using suture anchors into the talus combined with the transosseous suture in the medial malleolar
PDF) Suture anchors for primary deltoid ligament repair associated with acute ankle fractures
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Conservative Functional Treatment of Acute Fibular Ligament Rupture of the Ankle (30.06.2023)
Role of the posterior deep deltoid ligament in ankle fracture stability: A biomechanical cadaver study
Frontiers A retrospective study of deltoid ligament repair versus syndesmotic fixation in lateral malleolus fracture combined with both deltoid ligament injury and inferior tibiofibular syndesmotic disruption
Ankle Sprain - Physiopedia
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Frontiers Nonoperative treatment of avulsion fracture of the anterior tibia with proximal fibular fracture: A case report
PDF) Deltoid Ligament Insufficiency
