J Korean Orthop Assoc.  2024 Feb;59(1):42-50. 10.4055/jkoa.2024.59.1.42 .

Comparison of Clinical Results between Deltoid Ligament Augmentation and Syndesmosis Screw Fixation in Bimalleolar Equivalent Fracture

• Yang JH
• Yoon SH
• Suh JW
• Choi SJ
• Park HW

• KMID: 2553347
• DOI: http://doi.org/10.4055/jkoa.2024.59.1.42

Abstract

Purpose
The current treatment option of bimalleolar equivalent fractures is open reduction and internal fixation of lateral malleolus followed by syndesmotic screw fixation of syndesmosis or deltoid ligament augmentation. On the other hand, there is still debate using deltoid ligament augmentation technique. This study compared the clinical results of deltoid ligament augmentation and syndesmosis screw fixation in bimalleolar equivalent fractures.
Materials and Methods
From 2007 to 2022, this study retrospectively compared 31 patients who underwent deltoid ligament augmentation with fibula fixation with 12 patients who underwent syndesmosis fixation for bimalleolar equivalent fractures. The clinical results were compared by measuring visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and ankle range of motion 12 months after surgery. The radiological results were compared by measuring medial clear space, tibiofibular overlap, and tibiofibular clear space before and after surgery. The postoperative complications were compared.
Results
The post-operative AOFAS score, the VAS score, and the ankle range of motion were similar in the two groups. The radiological results showed a similar medial clear space, tibiofibular overlap, and tibiofibular clear space in the two groups before and after surgery. In addition, there were no postoperative complications in the group that underwent deltoid ligament augmentation, and one screw break and superficial infection were observed in each of the patient groups that had undergone trans-syndesmosis screw fixation.
Conclusion
Clinically good results could be obtained despite only deltoid ligament augmentation being performed alone after fibular fracture fixation in bimalleolar equivalent fractures. In addition, if only deltoid ligament augmentation is performed alone rather than transsyndesmosis screw fixation, there is little possibility of misalignment and no risk of screw breakage or the need for additional procedures to remove the screws. In conclusion, deltoid ligament repair without syndesmosis screw fixation could be viable for treating bimalleolar equivalent fractures.

Keyword

ankle; bimalleolar equivalent ankle fractures; tibiofibular ankle syndesmosis