Progress of diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yun ,  YANG Yunfeng

Department of Orthopedics, Shanghai Tongji Hospital, Shanghai, 200065, P.R.China;

Corresponding?author：

YANG Yunfeng, Email: dr.yang@hotmail.com

Keywords：

Ankle fracture; deltoid ligament; diagnosis; treatment

DOI：

10.7507/1002-1892.201701053

Video：

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Objective To review the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury. Methods Recent literature concerning the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury was reviewed. Results Misdiagnosis is common for ankle fractures combined with acute deltoid ligament injury. A diagnosis is given based on patients’ complaints, symptoms, and imaging examination, even surgical exploration is necessary. Whether to repair the deltoid ligament remains controversial. Conclusion Deltoid ligament is an important structure to stabilize the medial ankle joint. However, treatment of different kinds of ankle fractures combined with acute deltoid ligament injury should be standardized; whether or not repair deltoid ligament is determined by the intraoperative ankle stability.

Citation： ZHANG Yun, YANG Yunfeng. Progress of diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(5): 624-628. doi: 10.7507/1002-1892.201701053 Copy

1.	?Golanó P, Vega J, de Leeuw OA, et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 944-956.
2.	Mengiardi B, Pfirrmann CW, Vienne P, et al. Medial collateral ligament complex of the ankle: MR appearance in asymptomatic subjects. Radiology, 2007, 242(3): 817-824.
3.	Mengiardi B, Pinto C, Zanetti M. Medial collateral ligament complex of the ankle: MR imaging anatomy and findings in medial instability. Semin Musculoskelet Radiol, 2016, 20(1): 91-103.
4.	Panchani PN, Chappell TM, Moore GD, et al. Anatomic study of the deltoid ligament of the ankle. Foot Ankle Int, 2014, 35(9): 916-921.
5.	Savage-Elliott I, Murawski CD, Smyth NA, et al. The deltoid ligament: an in-depth review of anatomy, function, and treatment strategies. Knee Surg Sports Traumatol Arthrosc, 2013, 21(6): 1316-1327.
6.	Stufkens SA, van den Bekeron MP, Knupp M, et al. The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review. Strategies Trauma Limb Reconstr, 2012, 7(2): 73-85.
7.	Ziai P, Benca E, Skrbensky GV, et al. The role of the medial ligaments in lateral stabilization of the ankle joint: anin vitro study. Knee Surg Sports Traumatol Arthrosc, 2013, 23(7): 1900-1906.
8.	Clarke HJ, Michelson JD, Cox QG, et al. Tibio-talar stability in bimalleolar ankle fractures: a dynamicin vitro contact area study. Foot Ankle, 1991, 11(4): 222-227.
9.	Earll M, Wayne J, Brodrick C, et al. Contribution of the deltoid ligament to ankle joint contact characteristics: a cadaver study. Foot Ankle Int, 1996, 17(6): 317-324.
10.	Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg (Am), 1956, 38(4): 761-781.
11.	Harper MC. Mechanical considerations for the syndesmosis screw. A cadaver study. J Bone Joint Surg (Am), 1990, 71(10): 1575-1576.
12.	Rasmussen O. Stability of the Ankle Joint. Acta Orthopaedica, 1985, 56(Supp 211): 1-75.
13.	Davidovitch RI, Egol KA. The medial malleolus osteoligamentous complex and its role in ankle fractures. Bull NYU Hosp Jt Dis, 2009, 67(4): 318-324.
14.	Gill JB, Risko T, Raducan V, et al. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Joint Surg (Am), 2007, 89(5): 994-999.
15.	Park SS, Kubiak EN, Egol KA, et al. Stress radiographs after ankle fracture: the effect of ankle position and deltoid ligament status on medial clear space measurements. J Orthop Trauma, 2006, 20(1): 11-18.
16.	Nortunen S, Lepoj?rvi S, Savola O, et al. Stability assessment of the ankle mortise in supination-external rotation-type ankle fractures: lack of additional diagnostic value of MRI. J Bone Joint Surg (Am), 2014, 96(22): 1855-1862.
17.	Weber M, Burmeister H, Flueckiger G, et al. The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle. Arch Orthop Trauma Surg, 2010, 130(5): 693-698.
18.	伍凱, 林健, 黃建華, 等. 急性踝關節骨折伴三角韌帶損傷術中診斷及治療策略. 國際骨科學雜志, 2015, 36(2): 141-145.
19.	Yu GR, Zhang MZ, Aiver A, et al. Repair of the acute deltoid ligament complex rupture associated with ankle fractures: a multicenter clinical study. J Foot Ankle Surg, 2015, 54(2): 198-202.
20.	王淑麗, 馬信龍, 徐衛國, 等. 外踝骨折后三角韌帶損傷程度的 X 線與 MRI 比較研究. 中華骨科雜志, 2013, 33(8): 834-841.
21.	Henari S, Banks LN, Radovanovic I, et al. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle. Orthopedics, 2011, 34(10): e639-643.
22.	楊清雅, 徐志斌, 王進. 高頻三維超聲對三角韌帶斷裂的診斷價值. 中華實用診斷與治療雜志, 2014, 28(10): 1024-1025.
23.	Hintermann B, Regazzoni P, Lampert C, et al. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg (Br), 2000, 82(3): 345-351.
24.	Schuberth JM, Collman DR, Rush SM, et al. Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments. J Foot Ankle Surg, 2004, 43(1): 20-29.
25.	Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma, 2015, 29(12): 547-548.
26.	Stromsoe K, Hoqevold HE, Skjeldal S, et al. The repair of a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Joint Surg (Br), 1995, 77(6): 920-921.
27.	Maynou C, Lasage P, Mestdagh H, et al. Is surgical treatment of deltoid ligament rupture necessary in ankle fractures? Rev Chir Orthop Reparatric Appar Mot, 1997, 83(7): 652-657.
28.	Harper MC. The deltoid ligament: An evaluation of need for surgical repair. Clin Orthop Relat Res, 1988, 226(226): 156-168.
29.	王海鵬, 顧崢嶸, 劉云吉, 等. 手術治療踝關節骨折伴三角韌帶損傷的療效觀察. 中國修復重建外科雜志, 2015, 29(4): 416-419.
30.	陳宇杰, 施忠民, 李曉林, 等. 帶線錨釘治療Ⅳ度旋前-外旋踝關節骨折的初步效果. 中國修復重建外科雜志, 2009, 23(5): 577-580.
31.	朱敏, 徐永清, 丁晶, 等. 手術治療三角韌帶完全斷裂的旋前外旋型踝關節骨折. 實用骨科雜志, 2015, 21(8): 699-701.
32.	曹鵬, 韓小平, 王武, 等. 帶線錨釘在踝關節三角韌帶損傷修復中的應用. 實用骨科雜志, 2013, 19(9): 857-858.
33.	高武長, 王英振. 切開復位內固定踝關節骨折: 聯合帶線錨釘修復三角韌帶損傷的意義. 中國組織工程研究, 2016, 20(9): 1255-1260.

1. ?Golanó P, Vega J, de Leeuw OA, et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 944-956.
2. Mengiardi B, Pfirrmann CW, Vienne P, et al. Medial collateral ligament complex of the ankle: MR appearance in asymptomatic subjects. Radiology, 2007, 242(3): 817-824.
3. Mengiardi B, Pinto C, Zanetti M. Medial collateral ligament complex of the ankle: MR imaging anatomy and findings in medial instability. Semin Musculoskelet Radiol, 2016, 20(1): 91-103.
4. Panchani PN, Chappell TM, Moore GD, et al. Anatomic study of the deltoid ligament of the ankle. Foot Ankle Int, 2014, 35(9): 916-921.
5. Savage-Elliott I, Murawski CD, Smyth NA, et al. The deltoid ligament: an in-depth review of anatomy, function, and treatment strategies. Knee Surg Sports Traumatol Arthrosc, 2013, 21(6): 1316-1327.
6. Stufkens SA, van den Bekeron MP, Knupp M, et al. The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review. Strategies Trauma Limb Reconstr, 2012, 7(2): 73-85.
7. Ziai P, Benca E, Skrbensky GV, et al. The role of the medial ligaments in lateral stabilization of the ankle joint: anin vitro study. Knee Surg Sports Traumatol Arthrosc, 2013, 23(7): 1900-1906.
8. Clarke HJ, Michelson JD, Cox QG, et al. Tibio-talar stability in bimalleolar ankle fractures: a dynamicin vitro contact area study. Foot Ankle, 1991, 11(4): 222-227.
9. Earll M, Wayne J, Brodrick C, et al. Contribution of the deltoid ligament to ankle joint contact characteristics: a cadaver study. Foot Ankle Int, 1996, 17(6): 317-324.
10. Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg (Am), 1956, 38(4): 761-781.
11. Harper MC. Mechanical considerations for the syndesmosis screw. A cadaver study. J Bone Joint Surg (Am), 1990, 71(10): 1575-1576.
12. Rasmussen O. Stability of the Ankle Joint. Acta Orthopaedica, 1985, 56(Supp 211): 1-75.
13. Davidovitch RI, Egol KA. The medial malleolus osteoligamentous complex and its role in ankle fractures. Bull NYU Hosp Jt Dis, 2009, 67(4): 318-324.
14. Gill JB, Risko T, Raducan V, et al. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Joint Surg (Am), 2007, 89(5): 994-999.
15. Park SS, Kubiak EN, Egol KA, et al. Stress radiographs after ankle fracture: the effect of ankle position and deltoid ligament status on medial clear space measurements. J Orthop Trauma, 2006, 20(1): 11-18.
16. Nortunen S, Lepoj?rvi S, Savola O, et al. Stability assessment of the ankle mortise in supination-external rotation-type ankle fractures: lack of additional diagnostic value of MRI. J Bone Joint Surg (Am), 2014, 96(22): 1855-1862.
17. Weber M, Burmeister H, Flueckiger G, et al. The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle. Arch Orthop Trauma Surg, 2010, 130(5): 693-698.
18. 伍凱, 林健, 黃建華, 等. 急性踝關節骨折伴三角韌帶損傷術中診斷及治療策略. 國際骨科學雜志, 2015, 36(2): 141-145.
19. Yu GR, Zhang MZ, Aiver A, et al. Repair of the acute deltoid ligament complex rupture associated with ankle fractures: a multicenter clinical study. J Foot Ankle Surg, 2015, 54(2): 198-202.
20. 王淑麗, 馬信龍, 徐衛國, 等. 外踝骨折后三角韌帶損傷程度的 X 線與 MRI 比較研究. 中華骨科雜志, 2013, 33(8): 834-841.
21. Henari S, Banks LN, Radovanovic I, et al. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle. Orthopedics, 2011, 34(10): e639-643.
22. 楊清雅, 徐志斌, 王進. 高頻三維超聲對三角韌帶斷裂的診斷價值. 中華實用診斷與治療雜志, 2014, 28(10): 1024-1025.
23. Hintermann B, Regazzoni P, Lampert C, et al. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg (Br), 2000, 82(3): 345-351.
24. Schuberth JM, Collman DR, Rush SM, et al. Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments. J Foot Ankle Surg, 2004, 43(1): 20-29.
25. Warner SJ, Garner MR, Hinds RM, et al. Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma, 2015, 29(12): 547-548.
26. Stromsoe K, Hoqevold HE, Skjeldal S, et al. The repair of a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Joint Surg (Br), 1995, 77(6): 920-921.
27. Maynou C, Lasage P, Mestdagh H, et al. Is surgical treatment of deltoid ligament rupture necessary in ankle fractures? Rev Chir Orthop Reparatric Appar Mot, 1997, 83(7): 652-657.
28. Harper MC. The deltoid ligament: An evaluation of need for surgical repair. Clin Orthop Relat Res, 1988, 226(226): 156-168.
29. 王海鵬, 顧崢嶸, 劉云吉, 等. 手術治療踝關節骨折伴三角韌帶損傷的療效觀察. 中國修復重建外科雜志, 2015, 29(4): 416-419.
30. 陳宇杰, 施忠民, 李曉林, 等. 帶線錨釘治療Ⅳ度旋前-外旋踝關節骨折的初步效果. 中國修復重建外科雜志, 2009, 23(5): 577-580.
31. 朱敏, 徐永清, 丁晶, 等. 手術治療三角韌帶完全斷裂的旋前外旋型踝關節骨折. 實用骨科雜志, 2015, 21(8): 699-701.
32. 曹鵬, 韓小平, 王武, 等. 帶線錨釘在踝關節三角韌帶損傷修復中的應用. 實用骨科雜志, 2013, 19(9): 857-858.
33. 高武長, 王英振. 切開復位內固定踝關節骨折: 聯合帶線錨釘修復三角韌帶損傷的意義. 中國組織工程研究, 2016, 20(9): 1255-1260.

Chinese Journal of Reparative and Reconstructive Surgery

Progress of diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury

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