[Operation-effect analysis of 21 patients with ankle fracture and complete rupture of deltoid ligament].
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Abstract:
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.Keywords:
Malleolus
Deltoid curve
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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.
Malleolus
Deltoid curve
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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.
Deltoid curve
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In the past three years, we have experienced sixteen cases of fracture-dislocation of the ankle.1) We've generally chosen open reduction and internal fixation to the severe fracture-dislocation of the ankle.2) About fractures of the posterior malleolus of the tibia, we have recommended the internal fixation if the displacememt of the tibial articular surface is over the one third.3) Principally the diastases of the distal tibio-fibular ligament have been treated by the tibio-fibular fixation using the bolt and we think the removal of the bolt had better been done as soon as the tibio-fibular ligament is healed.4) The rupture of the deltoid ligament primary should be operated upon and sutured.
Medial malleolus
Malleolus
Syndesmosis
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Lateral malleolus
Medial malleolus
Malleolus
Deltoid curve
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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.
Deltoid curve
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Medial malleolus
Lateral malleolus
Malleolus
Medial collateral ligament
Deltoid curve
Ankle 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.
Deltoid curve
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To determine what factors were important in final clinical results, we evaluated 145 patients admitted to Vanderbilt University Hospital with ankle fractures between January 1971 and December 1976. There was a strong correlation between anatomic results of reduction and final clinical results. Talar displacement of more than 5 mm before reduction, a posterior malleolus fracture involving more than 25% of the articular surface, an anterior tibial plafond fracture involving more than 25% of the articular surface, and talus fractures involving the articular surface were four variables which significantly affected results. Open reduction, torn deltoid ligaments, open fractures, type of fracture, type of internal fixation devices used, sex, and age did not signficantly affect results. Other injuries in association with ankle fractures, especially after automobile accidents, frequently prolonged hospitalization.
Malleolus
Articular surface
Deltoid curve
Lateral malleolus
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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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