[EFFECTIVENESS OF SURGERY IN TREATMENT OF ANKLE FRACTURES ASSOCIATED WITH DELTOID LIGAMENT INJURY].
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To evaluate the effectiveness of repairing the deltoid ligament with ankle fracture.Between January 2010 and January 2013, 11 patients with ankle fractures associated with deltoid ligament injury were treated. There were 7 males and 4 females, with an average age of 38.2 years (range, 18-72 years). The interval between injury and operation was 6 hours to 7 days (mean, 4 days). According to Lauge-Hansen classification, ankle fracture was rated as pronation-external rotation type in 5 cases, as supination-external rotation type in 4 cases, and as pronation-abduction type in 2 cases. The MRI and color Doppler ultrasound showed deltoid ligament rupture. The results of valgus stress test, talus valgus tilt test, and anterior drawer test after anesthesia were all positive. Fracture was treated by open reduction and internal fixation, and deltoid injury was repaired.All incisions healed primarily. All patients were followed up 12-18 months (mean, 13.3 months). The X-ray films showed anatomical reduction, good position of internal fixation and stable distal tibiofibular syndesmosis. The mean fracture union time was 7.6 weeks (range, 6-8 weeks). MRI at 3 months after operation showed normal shape of the deltoid ligament. According to American Orthopaedic Foot and Ankle Society (AOFAS) score, the results were excellent in 6 cases, good in 3 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 81.8%.It is an effective method to treat ankle fracture with deltoid ligament injury by open reduction and internal fixation of ankle fracture and repair of the deltoid ligament injury, which can effectively rebuild medial instability and has satisfactory effectiveness.Keywords:
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To explore short-term clinical effect of surgical treatment for ankle fracture with complete rupture of deltoid ligament in young and middle-aged patients.From January 2016 to March 2019, 21 young and middle-aged patients with ankle joint fracture and complete rupture of the deltoid ligament were treated with internal fixation and repair of the medial deltoid ligament, including 16 males and 5 females, aged from 21 to 52 years old with an average of (38.6±7.3) years old, the time from injury to operation ranged from 1 to 7 days with an average of (3.8±1.5) days. Fracture healing time and complications were observed, changes of medial malleolus clearance before and after operation were compared, American Orthopaedic Foot and Ankle Society (AOFAS) score wasused to evaluate function of ankle joint at 18 months after operation.Twenty-one patients were followed up from 18 to 26 months with an average of (21.7±1.2) months. The incisions were healed at stageⅠ, and fracture healing time ranged from 8 to 12 weeks with an average of (9.5±1.6) weeks. No wound infection, failure of internal fixation, and nerve injury occurred. Medial malleoius space decreased from (5.83±0.32) mm before operation to (2.69±0.25) mm after operation. Postoperative AOFAS score at 18 months was 91.43±4.14, 14 patients got excellent results, 6 good and 1 fair.On the basis of stable fixation of fracture, repair of deltoid ligament could help restoring the medial anatomy of ankle joint in young and middle-aged patients, and could achieve good short term clinical effect.
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Unstable fracture-dislocation of the ankle is a common lower-extremity injury. Treatment is challenging when the fracture-dislocation is open and cannot be treated with conventional open reduction and internal fixation (ORIF). Immediate ORIF may not be possible for severe, unstable ankle injuries, such as those with ischemic foot because of a poor blood supply caused by soft-tissue injury, or open fracture-dislocation of the ankle with a deltoid ligament rupture. We describe a staged treatment for unstable open fracture-dislocation of the ankle with a deltoid ligament rupture. The first stage involves temporary vertical transarticular pinning combined with external fixation. The second stage involves delayed definitive plating with autogenous bone graft for the bone defect of the distal fibula. This staged management is useful in select emergency cases of unstable open fracture-dislocations of the ankle combined with deltoid ligament rupture for which conventional ORIF cannot be performed.
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Ankle fractures are common lower extremity fractures that pose a significant economic and social burden. This study analyzed the ankle fracture research literature between 2000 and 2021 to clarify the current status of ankle fracture research and predict future research trends.Publications related to ankle fractures published between 2000 and 2021 were retrieved from the Web of Science Core Collection. Then Bibliometric analysis and Visualized Study were performed by VOSviewer software.A total of 2656 publications were retrieved. The number of publications related to ankle fractures is increasing every year. The top countries and journals in terms of the total number of publications, number of citations, and H-index ranking were USA and foot and ankle int. Lorich DG had the most publications in this field. University of Amsterdam's research group had the biggest number of publications in this field. Co-occurrence analysis clustered the keywords into seven clusters: survival analysis and prognosis study, internal fixation treatment study, treatment study of combined deltoid ligament rupture, treatment study of combined inferior tibiofibular ligament injury, treatment study of posterior ankle fracture, treatment study of postoperative traumatic arthritis of ankle fracture, and treatment study of ankle injury in children.The importance of ankle fractures is increasing year by year with the aging process, and the number of publications related to ankle fractures will not continue to increase in the future. Survival and prognosis studies, internal fixation studies, combined deltoid ligament rupture studies, and combined inferior tibiofibular ligament injury studies may become the future research hotspots in the field of ankle fractures.
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Lateral malleolus
Medial malleolus
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Objective To explore surgical repairing of ankle fracture accompanied with the deltoid ligament damage.Methods 17 patients with ankle fracture accompanied with the deltoid ligament rupture were treated by open reduction,intensified internal fixation,and restoration of broken ligaments.After the surgery,patients were followed up and analyzed.Results The American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score was used to evaluate clinical results of the treatment.In all cases,6 were excellent,7 good,3 passable,and only 1 poor.The rate of good and excellence was about 76.47%.Conclusions For cases of ankle fracture combined with deltoid ligament rupture,surgical treatment is helpful for recovering mechanical stability of ankle joint.
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Deltoid ligament injury occurs often with supination-external rotation (SER) ankle trauma. SER fibula fractures with concomitant deltoid ligament injury are considered unstable-requiring operative fixation. Recent studies have questioned this general practice with emphasis on better defining the medial side ankle ligamentous injury. The function of the individual bands of the deltoid ligament, and the interplay between them, are not fully understood. We undertook this study to develop a better understanding of these complex ligamentous structures and ultimately aid assessment and treatment choice of SER ankle fractures with concomitant deltoid ligament injuries.Ten fresh-frozen cadaveric foot and ankle specimens were studied. We identified the various ligament bands and did a functional analysis by assessment of ligament length and tension at predefined angles of ankle dorsi-plantarflexion combined with valgus/varus and rotation. The results were determined by manual evaluation with calipers and goniometers, manual stress, and direct visualization.We recorded primarily 5 different bands of the deltoid ligament: the tibionavicular (TNL; 10/10) tibiospring (TSL; 9/10), tibiocalcaneal (TCL; 10/10), deep anterior tibiotalar (dATTL; 9/10), and deep posterior tibiotalar (dPTTL; 10/10) ligaments. The tibiospring ligament was tense in plantarflexion, while the tibiocalcaneal and deep posterior tibiotalar ligaments were tense in dorsiflexion. The superficial layer ligaments and the deep anterior tibiotalar ligament length and tension were largely affected by changes in varus/valgus and rotation. The deep posterior tibiotalar ligament length and tension was altered predominantly by changes in dorsi-plantarflexion; varus/valgus positioning had a minor effect on this band.We confirmed the finding of previous studies that dorsi-plantarflexion affects the tensile engagement of the separate ligament bands differently. Likewise, combined movements with varus/valgus and rotation seem to affect the separate ligament bands differently. Our results suggest that the TNL, TSL, and dATTL are at risk of injury, whereas the TCL and particularly the dPTTL are protected in the event of an SER-type ankle fracture mechanism of injury.Level V, cadaveric study.
Syndesmosis
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Deltoid curve
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To evaluate the effectiveness of repairing the deltoid ligament with ankle fracture.Between January 2010 and January 2013, 11 patients with ankle fractures associated with deltoid ligament injury were treated. There were 7 males and 4 females, with an average age of 38.2 years (range, 18-72 years). The interval between injury and operation was 6 hours to 7 days (mean, 4 days). According to Lauge-Hansen classification, ankle fracture was rated as pronation-external rotation type in 5 cases, as supination-external rotation type in 4 cases, and as pronation-abduction type in 2 cases. The MRI and color Doppler ultrasound showed deltoid ligament rupture. The results of valgus stress test, talus valgus tilt test, and anterior drawer test after anesthesia were all positive. Fracture was treated by open reduction and internal fixation, and deltoid injury was repaired.All incisions healed primarily. All patients were followed up 12-18 months (mean, 13.3 months). The X-ray films showed anatomical reduction, good position of internal fixation and stable distal tibiofibular syndesmosis. The mean fracture union time was 7.6 weeks (range, 6-8 weeks). MRI at 3 months after operation showed normal shape of the deltoid ligament. According to American Orthopaedic Foot and Ankle Society (AOFAS) score, the results were excellent in 6 cases, good in 3 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 81.8%.It is an effective method to treat ankle fracture with deltoid ligament injury by open reduction and internal fixation of ankle fracture and repair of the deltoid ligament injury, which can effectively rebuild medial instability and has satisfactory effectiveness.
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Objective
To investigate the clinical outcomes of different managements of complete rupture of the deltoid ligament associated with supination-external rotation ankle fracture.
Methods
From January 2010 to June 2014, 33 cases of complete rupture of the deltoid ligament associated with supination-external rotation ankle fracture were treated with open reduction and internal fixation. According to the different managements of the complete rupture of the deltoid ligament, the patients were divided into 4 groups: 9 cases in the non-repair group, 7 cases in the superficial layer repair group, 9 cases in the deep layer repair group, and 8 cases in the complete repair group. All the patients took anteroposterior, lateral and gravity stress radiographs preoperatively and postoperatively. The 4 groups were compatible in preoperative general data (P > 0.05). The 4 groups were compared in terms of operation time, medial clear space and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.
Results
All the patients were followed up for 6 to 18 months (average, 13.7 months). All wounds healed at the first stage without any infection. All fractures united primarily after 3 to 9 months (average, 4.7 months). The operation time for the superficial layer repair group was significantly longer than for the non-repair group, but significantly shorter than for the deep layer repair and the complete repair groups (P 0.05), but there were significant differences before and after operation in the 4 groups (P < 0.05) . The postoperative AOFAS ankle-hindfoot score in the repair groups was significantly higher than in the non-repair group and the superficial layer repair group (P <0.05).
Conclusion
To achieve satisfactory outcomes for patients with complete rupture of the deltoid ligament associated with supination-external rotation ankle fractures, anatomic open reduction and rigid internal fixation is necessary, and repair of the deltoid ligament, especially its superficial layer, is a valuable contribution.
Key words:
Ankle joint; Fractures, bone; Ligament; Surgical procedures, operative; Ligament repair
External rotation
Deltoid curve
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Objective To explore the operative methods and curative effects of the deltoid ligament injuries. Methods From 2002 to 2008, all 61 patients with ankle fractures complicated with deltoid ligament injuries were treated with open reduction and firm internal fixation. Among the patients, 39 patients were male and 22 patients were female, ranging in age from 14 to 71 years, with an average of 41 years. During the operation, the deltoid ligament was reconstructed to restore the medial and lateral stability of ankle joint. Results All the patients were followed up ranged from 5 to 30 months, with an average of 17 months. Fifty-nine patients had incision healed at the first stage; 2 patients had superficial infections at lateral malleolus, and healed at the 3rd week after changing dressings. The incisions at the internal medial malleolus were all healed at the first stage. According to Qi evaluation criteria, 35 patients got an excellent result, 13 good and 13 fair. Conclusion The deltoid ligament should be treated properly in the treatment of ankle joint fractures when open reduction and firm internal fixation were emphasized.
Lateral malleolus
Deltoid curve
Medial malleolus
Malleolus
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