A Clinical Study of Disruption of the Deltoid Ligament Associated with Fractures of Distal Fibula / 대한정형외과학회잡지

It is been known that the deltoid ligament of the ankle joint plays an important role in the stabiliy of the ankle joint. In cases of deltoid ligament rupture, associated with lateral malleolar fractures, cannot be maintained the integrity of the mortise and the stability of the talus. Controversy remains about the treatment of deltoid ligament injuries. Many authors advocate an operative repair for deltoid ligament ruptures for optimal reduction of lateral malleolar fracture. However, according to recent cadaveric studies and many satisfactory results of clinical studies, excellent results have been reported regarding the ankle joint stability by anatomical reduction of the lateral structure, but only without surgical repair of the medial structure. Fourteen patients with lateral malleolar fractures with associated deltoid ligament injuries treated at Sun General Hospital between January 1990 and June 1995. There were examined clinically and radiologically. We concluded that deltoid ligament repairs should be considered unnecessary as long as fibular fracture are stabilized anatomically with normal medial joint space. However, in cases with higher fracture levels of lateral malleolus, associated with syndesmotic injury, we recommend syndesmotic screw fixation or deltoid ligament repair.

Comparative Analysis of Trans-syndesmotic Versus Non-syndesmotic Screw Fixation in Surgical Treatment of Ankle Fracture with Diastasis / 대한정형외과학회잡지

Fibular fractures that begin proximal to the tibial plafond are assumed to include an injury of the syndesmosis. Many surgeons have treated this injuries by rigidly repairing the medial and lateral malleoli with trans-syndesmotic fixation. However, recently, some demonstrated that a trans-syndesmotic screw places biomechanical restrictions on the tibiotalar joint and is not required to maintain the integrity of the distal tibiofibular joint in cadava models. Thirty eight patients of ankle fracture with syndesmotic injury treated at Sun General Hospital from January 1989 to June 1994 week analyzed in clinical and radiologic aspect. The results obtained from this study were as followings. 1. If rigid anatomic medial and lateral joint fixation was obtained, syndesmotic screw fixation was not required to maintain the integrity of the syndesmotic. 2. Repairting the deltoid ligament did not enhance treatment results when fibular fracture and syndesmotic had been fixed anatomically. Therefore, we believe that syndesmotic screw fixation was indicated only when medial and lateral stabilization could not be achieved adequately.