Table 2.
Clinical studies evaluating suturing of the deltoid ligament after ankle fractures
| Author | Study level | Number of patients treated | Type of injury | Number of patients available for follow-up | Mean follow-up (months) | Sutured | Outcome | Not sutured | Outcome | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|
| Baird and Jackson [3] | IV | 70 | Distal fibular fracture and disruption of the deltoid ligament | 24 (13 SE#, 11 PE#) | 36 | 3 | 1 SE# excellent, 2 PE# poor | 21 | 8 SE# excellent, 5 PE# excellent, 3 SE# good, 3 PE# good, 1 SE# fair, 1 PE# poor | 90 % of the nonrepaired ligaments had a good or excellent result. Only if the medial clear space remains widened after fracture reduction does the medial side need to be explored |
| Harper [45] | IV | 42 | Fracture dislocations of the ankle | 36 (18 SE#, 15 PE#, 2 maisonneuve, 1 syndesmotic diastasis | 30 | 0 | – | 36 | 12 SE# good, 4 SE# fair, 2 SE# poor, 14 PE# good, 1 PE# poor, 1 maisonneuve good, 1 maisonneuve poor, 1 diastasis good | The deltoid ligament will heal sufficiently with nonoperative treatment, provided that the medial joint space is maintained in a reduced position |
| Zeegers and van der Werken [133] | IV | 28 | Ankle fracture associated with a ruptured deltoid ligament | 28 (12 SE#, 10 PE#, 6 PA#) | 18 | 0 | – | 28 | 20 patients (very) good, 8 patients poor | After anatomical reconstruction of the lateral malleolus with perfect congruity of the ankle mortise there is no need to explore and suture the ruptured deltoid ligament |
| Strömsöe et al. [122] | II | 50 | Weber B and C types and a ruptured deltoid ligament | 50 (30 Weber B, 20 Weber C) | 17 | 25 | No differences between groups | 25 | No differences between groups | A ruptured deltoid can be left unexplored. Operating time is reduced and the skin over the medial malleolus is left untouched |
| Maynou et al. [77] | III | 44 | Ankle fractures with deltoid ligament rupture | 44 (7 OCD and 2 malreductions) were evaluated separately | 56 | 18 | 2 medial instability | 17 | 2 medial instability, more ossifications of the deltoid (p = 0.013), 1 posttraumatic osteoarthritis | Repair of the deltoid ligament is unnecessary if the internal fixation of the fibula achieves an anatomical reconstrucion of the mortise |
| Tourne et al. [126] | IV | 48 | Weber A, B and C fractures with a ruptured medial collateral ligament | 33 | 27 | 0 | – | 33 | 82.5 % excellent and good, 73 % normal Rx, 15 % anterior impingement, 12 % deltoid calcifications | Suggestion to leave the ligament tears unexplored (medial, tibiofibular, and syndesmotic) |