Biomechanical Effect on Joint Stability of Including Deltoid Ligament Repair in an Ankle Fracture Soft Tissue Injury Model With Deltoid and Syndesmotic Disruption

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.

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IFATS Collection: Human Adipose-Derived Stem Cells Seeded on a Silk Fibroin-Chitosan Scaffold Enhance Wound Repair in a Murine Soft Tissue Injury Model

Stem Cells ◽

10.1634/stemcells.2008-0178 ◽

2009 ◽

Vol 27 (1) ◽

pp. 250-258 ◽

Cited By ~ 161

Author(s):

Andrew M. Altman ◽

Yasheng Yan ◽

Nadine Matthias ◽

Xiaowen Bai ◽

Carmen Rios ◽

...

Keyword(s):

Stem Cells ◽

Soft Tissue ◽

Silk Fibroin ◽

Wound Repair ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Adipose Derived Stem Cells ◽

Chitosan Scaffold ◽

Injury Model

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Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

10.21203/rs.2.11749/v3 ◽

2019 ◽

Author(s):

Bohua Li ◽

Shanxi Wang ◽

Zhengdong Zhang ◽

Hai Yang ◽

Jun Li ◽

...

Keyword(s):

External Fixation ◽

External Rotation ◽

Ankle Fractures ◽

Deltoid Ligament ◽

Functional Evaluation ◽

Ligament Repair ◽

Fracture Union ◽

Group 2 ◽

Supination External Rotation ◽

Group 1

Abstract Background The topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures. Methods Between January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation. Results In both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P < 0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2. Conclusions ORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union. Keywords Transarticular external fixation; ORIF; Deltoid ligament repair; Supination-external rotation; Ankle fracture

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Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

10.21203/rs.2.11749/v2 ◽

2019 ◽

Author(s):

Bohua Li ◽

Shanxi Wang ◽

Zhengdong Zhang ◽

Hai Yang ◽

Jun Li ◽

...

Keyword(s):

External Fixation ◽

External Rotation ◽

Ankle Fractures ◽

Deltoid Ligament ◽

Functional Evaluation ◽

Ligament Repair ◽

Fracture Union ◽

Group 2 ◽

Supination External Rotation ◽

Group 1

Abstract Background The topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures. Methods Between January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation. Results In both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P < 0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2. Conclusions ORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union. Keywords Transarticular external fixation; ORIF; Deltoid ligament repair; Supination-external rotation; Ankle fracture

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Effect of Deltoid Ligament Repair versus Syndesmosis Fixation on Ankle Joint Stability After Bimalleolar Equivalent Ankle Fracture

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00087 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0008 ◽

Cited By ~ 1

Author(s):

Pablo Mococain ◽

Richard Glisson ◽

Diana Lorena Bejarano-Pineda ◽

James Nunley ◽

Mark Easley

Keyword(s):

Ankle Joint ◽

Ankle Fracture ◽

Axial Load ◽

Screw Fixation ◽

External Rotation ◽

Lateral Malleolus ◽

Deltoid Ligament ◽

Joint Stability ◽

Ligament Repair ◽

Syndesmotic Screw

Category: Trauma Introduction/Purpose: The current standard for stabilization of the talus within the ankle mortise after bimalleolar equivalent ankle fracture is open reduction and internal fixation (ORIF) of the lateral malleolus followed by syndesmotic screw fixation of the syndesmosis. Syndesmotic fixation may be associated with complications such as mal-reduction, joint stiffness, altered ankle biomechanics, and potential additional surgery for hardware removal. Consequently, some surgeons advocate ORIF of the lateral malleolus in conjunction with deltoid ligament repair rather than syndesmosis fixation. To our knowledge, clinical reports of this treatment option lack biomechanical evidence to support this approach. The purpose of this investigation was to compare ankle joint stability and contact pressures in a bimalleolar equivalent ankle fracture model treated with trans-syndesmotic screw fixation versus deltoid ligament repair. Methods: We prepared and tested seven fresh frozen cadaveric whole lower leg specimens with an undisturbed proximal tibiofibular joint. We tested each leg was tested under five conditions: (1) intact, (2) syndesmosis disrupted and deltoid ligament sectioned, (3) syndesmosis reduced w/ screw fixation, (4) deltoid repaired, and (5) both syndesmosis and deltoid ligament repaired. Under a nominal axial load, we applied controlled anterior, posterior, lateral, and medial drawer stresses to the foot using a custom-built testing apparatus and documented the resulting talar translation relative to the tibia. We also applied controlled internal and external rotation stresses to the ankle model and measured the provoked ankle joint rotations. In each condition, we measured peak ankle contact pressure (PACP) using a Tekscan pressure sensor under a physiologic axial load simulating single-limb stance. Results: Concurrent disruption of the syndesmosis and the deltoid ligament significantly (p<.05) increased anterior drawer, lateral drawer, and internal and external rotation. Subsequent deltoid repair significantly reduced anterior displacement to normal levels, but syndesmosis fixation did not. Lateral drawer was not significantly corrected until both deltoid ligament and syndesmosis were repaired. Deltoid repair and syndesmosis fixation each reduced internal rotation significantly, with further reduction to normal levels when both were repaired. External rotation remained elevated relative to the intact condition regardless of which structures were repaired. Deltoid repair and syndesmosis fixation achieved similar levels of posterior, lateral and medial drawer reduction, but these measures did not approach normal values until both were repaired. No significant differences in PACP were identified among the five tested conditions. Conclusion: Isolated repair of the deltoid ligament after a bimalleolar equivalent ankle fracture achieves markedly better anterior displacement stability than does fixation of the syndesmosis with a screw. Under the described testing conditions, the two procedures offer similar posterior, medial, and lateral talar displacement stability and similar levels of internal and external rotational stability. Given the complications that may be associated with rigid syndesmotic screw fixation, our investigation suggests that deltoid repair may represent a reasonable alternative to syndesmosis fixation.

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