SLR - April 2020 - Matthew D. Weber

Deltoid Ligament Repair Reduces and Stabilizes the Talus in Unstable Ankle Fractures 

Reference: Butler, B. A., Hempen, E. C., Barbosa, M., Muriuki, M., Havey, R. M., Nicolay, R. W., & Kadakia, A. R. (2020). Deltoid Ligament Repair Reduces and Stabilizes the Talus in Unstable Ankle Fractures.Journal of Orthopaedics,17, 87-90. 
Scientific Literature Review 

Reviewed By: Matthew D. Weber, DPM 
Residency Program: Hennepin County Medical Center – Minneapolis, MN 

Podiatric Relevance: There is extensive debate as to whether the deltoid ligament should be repaired acutely in ankle fractures. The decision whether to repair the deltoid or not can have an effect on ultimate stability of the ankle. While most authors agree that fixation of the lateral malleolus and syndesmosis is paramount in ultimate stabilization of these injuries, often the deltoid ligament is not addressed. There have been many non-comparative studies that show favorable outcomes with deltoid repair, however direct comparison studies have proven largely inconclusive.  

Methods: Twenty-one lower limbs were used for cadaveric testing (ages 41-73 years) without ankle or subtalar joint arthritis. The cadaver leg was disarticulated at the knee joint and preserved at the proximal tibiofibular joint. An artificial supination external rotation four-type fracture model was created on the cadaver limbs. The fibular fracture was then fixated with a standard six-hole plate and the deltoid ligament was repaired with #2 Fiberwire. The ankle fracture models were divided into ORIF with and without deltoid fixation and compared to an intact ankle model using hanging stress, axial force of 150 N, and external rotation stress of 1 Nm.  

Results: Compared to the intact ankle, the ORIF group alone showed significant talar eversion and axial rotation differences, as well as talar internal and external rotation. The ORIF with deltoid correction group had no significant differences from the intact group in terms of talar eversion, axial rotation, inversion stress, and eversion stress. 

Conclusion: Repair of the deltoid ligament in cadaveric models in this article was shown to stabilize the talus to pre-injury levels. Fixation alone without repair of the deltoid ligament in these models led to increased talar instability in several planes. However, considering these tests were done on cadaveric models, more research is necessary to determining the clinical significance of the findings of this article. 

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