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2022, Vol. 26 ›› Issue (11): 1793-1798Ankle joint fracture with deltoid ligament injury: repair and reconstructionLi Qichen1, Han Shufeng2, Jia Erlong2, Jia Yanan1
Abstract: BACKGROUND: The deltoid ligament is the most important structure to maintain the biomechanical stability of the medial malleolus. Improper handling for deltoid ligament injuries can cause traumatic arthritis and chronic ankle instability. However, there are still controversies regarding the diagnosis and treatment of ankle fractures with deltoid ligament injury. OBJECTIVE: To review the progress in the diagnosis and treatment of ankle fractures with deltoid ligament injury. METHODS: PubMed, CNKI and VIP were searched for relevant articles using the keywords of “ankle, deltoid ligament, diagnosis, management” in English and Chinese, respectively. After initial retrieval, 290 articles were enrolled and finally 69 eligible articles were included for further review. RESULTS AND CONCLUSION: The deltoid ligament limits the valgus and external rotation of the talus and stabilizes the medial malleolus. After deltoid ligament injury, the stability of the medial malleolus is reduced, and the force line of the hind foot gradually changes. Subsequently, related deformities occur, such as flat feet, which will lead to osteochondral degeneration of the ankle joint in the long term. Medial malleolus injuries can be confirmed based on an overall consideration of patient symptoms, imaging data, and ankle arthroscopy. Different types of ankle injuries have different coping strategies. The repair of the deltoid ligament is crucially important for ankle fractures combined with distal tibiofibular syndesmosis injury. In view of the various problems that may occur in distal tibiofibular joint fixation using screws, an exploration on the use of deltoid ligament instead of distal tibiofibular joint fixation is going on, avoiding secondary operations and poor reduction of the distal tibiofibular joint. Deltoid ligament repair has the disadvantages of long operation time, and suture-button fixation method can also avoid a series of problems caused by distal tibiofibular joint fixation using screws. Therefore, large-sample clinical trials are necessary to compare the postoperative effects of deltoid ligament repair and suture-button fixation for distal tibiofibular syndesmosis injury. Anchoring technique with wire is currently the most common method for the clinical repair of the medial collateral ligament. Key words:ankle fracture, deltoid ligament injury, medial stability of the ankle, distal tibiofibular syndesmosis injury, ankle osteoarthritis, wire anchor, distal tibiofibular screw |