[Unstable injuries of the deltoid ligament complex in ankle fractures : How to diagnose, how to treat?]

Kirschner Wire Internal Fixation of the Medial Tibiotalar Joint for Indirect Repair of Deltoid Ligament Injury: A Retrospective Comparative Study

OBJECTIVE

Ankle joint fractures are often accompanied by medial deltoid ligament rupture. There is controversy over whether or how to treat deltoid ligament rupture. This study was aimed to explore the feasibility of repairing the medial deltoid ligament using Kirschner wire internal fixation of the medial tibiotalar joint combined with external fixation.

METHODS

Forty-six patients with ankle fractures involving deltoid ligament rupture, treated between October 2012 and February 2021, were retrospectively evaluated. Twenty-five patients were treated with a Kirschner wire to fix the tibiotalar joint and indirectly repair the deltoid ligament as the repaired group. Twenty-one patients underwent reduction and fixation of internal and external malleolus fractures, and the deltoid ligament was not repaired in the unrepaired group. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS), Medical Outcomes Short Form 36-item questionnaire score (SF-36), and Medial clear space perpendicular (preoperative, postoperative, final follow-up) were used for functional evaluations and reduction assessments. Mann-Whitney test were used to compare the differences between the groups.

RESULTS

The follow-up time was 13-112 months with a mean of 59.32 months for the repaired group and 11-94 months with a mean of 53.43 months for the unrepaired group. There was no significant difference in the operative time or intraoperative blood loss between the two groups (p > 0.05). At the last follow-up, the AOFAS ankle-hindfoot and SF-36 scores of the repaired group were significantly higher than those of the non-repaired group (p < 0.05). Moreover, the VAS pain score was significantly lower and the Medial clear space perpendicular was significantly narrower in the repaired group than that in the unrepaired group.

CONCLUSION

Tibiotalar joint fixation using Kirschner wires is a simple and effective technique that can indirectly reduce and repair the deltoid ligament and stabilize the ankle.

Instabilität des oberen Sprunggelenks

Die symptomatische Bandinstabilität des oberen Sprunggelenks (OSG) ist eine häufige Pathologie und bedarf bei gescheiterter konservativer Therapie oft einer operativen Stabilisierung. Neben Anamnese und subjektiver Wahrnehmung des Patienten liefern klinische Untersuchung, funktionelle Diagnostik, Bildgebung und je nach Bedarf die Arthroskopie des Sprunggelenks wichtige Informationen. Meistens benötigt es eine Kombination mehrerer Untersuchungsmethoden, um die Diagnose einer behandlungsbedürftigen OSG-Instabilität zu stellen. Neben der Beurteilung der Stabilität ist ebenfalls die Feststellung von Zusatzpathologien wichtig. Dies beinhaltet auch das Erkennen einer pathologischen Rückfußachse, was essenziell für die weitere Behandlung sein kann. Die operative Therapie kann mittels Arthroskopie oder offener Operation mit weitgehend erfreulichen klinischen Resultaten durchgeführt werden.