$medial malleolus avulsion fracture$

$medial malleolus avulsion fracture$

#MEDIAL MALLEOLUS AVULSION FRACTURE PLUS#

They randomly allocated 20 patients to fibula ORIF alone and 20 to ORIF plus DLR with suture anchors. Gu and colleagues 9 conducted an RCT that included 40 patients with ankle fractures and deltoid ligament injury, as indicated by preoperative magnetic resonance imaging and MCS greater than 5 mm on preoperative stress radiographs.

$medial malleolus avulsion fracture$

The authors concluded that DLR was superfluous if a congruent mortise could be established intraoperatively. Deltoid ligament repair was associated with significantly longer operative time (75 min v. No between-group differences in working ability, sports activities engaged in, pain, swelling, metal removed or overall movement were observed. After an average follow-up duration of 17 months, both groups maintained a congruent mortise. The authors focused on the qualitative assessment of mortise congruency to establish adequate reductions both intraoperatively and postoperatively. Thirty-nine patients (19 in the DLR group and 20 in the no-repair group) were observed to have ruptured syndesmosis, but it was not specified which of these patients underwent syndesmotic fixation. The earliest study, carried out by Strömsöe and colleagues, 7 was an RCT in which 25 patients with Weber B or C fibula fractures were randomly allocated to DLR with fibula open reduction and internal fixation (ORIF), and 25 patients to fibula ORIF alone. Studies comparing deltoid ligament repair versus no repair We excluded reviews, technical papers, radiographic assessments of deltoid ligament integrity, studies of repairs for chronic deltoid ligament insufficiency, studies in languages other than English and studies lacking a comparison group. We included studies focusing on DLR in the context of acute ankle fractures, studies whose population comprised more than 50% adult (> 18 yr of age) patients and studies that included more than 5 patients. We also searched references of the final selected studies for relevant articles to reduce the likelihood of omitting pertinent articles. ti.kw.) search for deltoid ligament(s) in the title or author-supplied keyword fields. ti.kf.) search for deltoid ligament(s) in the title or author-supplied keyword fields Embase: (deltoid ligament*. We performed the search on May 23, 2020, using the following strategy: MEDLINE: (deltoid ligament*. To identify relevant studies, we used the Ovid search engine to search the Embase and MEDLINE electronic databases. We conducted a systematic review of the English-language literature in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines. We performed a systematic review with the primary aim of determining the breadth and quality of the literature evaluating DLR in the context of ankle fractures. In addition, if DLR can offer better stability and a more accurate reduction than syndesmotic fixation, this obviates the need for implant removal, which is sometimes associated with rigid syndesmotic fixation. Thus, if DLR is beneficial, particularly in a younger, more active patient population, it is an important operative adjunct to consider. 6, 7ĭeltoid ligament repair can be performed safely, efficiently and cost-effectively with modern techniques. 2 Deltoid ligament repair is controversial some surgeons believe that deltoid ligament integrity is vital to long-term ankle stability, 5 whereas others regard DLR as a time-consuming endeavour of little to no clinical benefit. Nevertheless, the prevailing clinical practice is to explore the medial side of the ankle only if there is a block to reduction.

$medial malleolus avulsion fracture$

4ĭeltoid ligament repair (DLR) was historically a common adjunct to ankle fracture fixation. Indications of deltoid ligament injury include medial clear space (MCS) greater than 5 mm on external rotation or gravity stress radiographs. 2 Thus, the deltoid ligament is vital in maintaining overall ankle stability and congruent force distribution in the ankle mortise. 3 The primary function of the superficial deltoid is to resist hindfoot eversion, whereas the primary function of the deep deltoid is to resist external rotation of the talus relative to the tibia. The deltoid ligament is a medial ankle structure consisting of the superficial deltoid (superficial posterior tibiotalar, tibiospring, tibiocalcaneal and tibionavicular ligaments) and deep deltoid (deep anterior and posterior tibiotalar ligaments). 2 Much attention has been devoted in the literature to syndesmotic ligaments on the lateral aspect of the ankle however, the deltoid ligament has received considerably less attention. Damage to ankle ligaments often occurs concomitant with bony injury 1 and, when left unaddressed, can lead to chronic ankle instability and accelerated posttraumatic arthritis. Ankle fractures are one of the most common injuries encountered in orthopedic practice.

$medial malleolus avulsion fracture$

Medial malleolus avulsion fracture