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, Lepojärvi 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.	伍凯, 林健, 黄建华, 等. 急性踝关节骨折伴三角韧带损伤术中诊断及治疗策略. 国际骨科学杂志, 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.	王淑丽, 马信龙, 徐卫国, 等. 外踝骨折后三角韧带损伤程度的 X 线与 MRI 比较研究. 中华骨科杂志, 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.	杨清雅, 徐志斌, 王进. 高频三维超声对三角韧带断裂的诊断价值. 中华实用诊断与治疗杂志, 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.	王海鹏, 顾峥嵘, 刘云吉, 等. 手术治疗踝关节骨折伴三角韧带损伤的疗效观察. 中国修复重建外科杂志, 2015, 29(4): 416-419.
30.	陈宇杰, 施忠民, 李晓林, 等. 带线锚钉治疗Ⅳ度旋前-外旋踝关节骨折的初步效果. 中国修复重建外科杂志, 2009, 23(5): 577-580.
31.	朱敏, 徐永清, 丁晶, 等. 手术治疗三角韧带完全断裂的旋前外旋型踝关节骨折. 实用骨科杂志, 2015, 21(8): 699-701.
32.	曹鹏, 韩小平, 王武, 等. 带线锚钉在踝关节三角韧带损伤修复中的应用. 实用骨科杂志, 2013, 19(9): 857-858.
33.	高武长, 王英振. 切开复位内固定踝关节骨折: 联合带线锚钉修复三角韧带损伤的意义. 中国组织工程研究, 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, Lepojärvi 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. 伍凯, 林健, 黄建华, 等. 急性踝关节骨折伴三角韧带损伤术中诊断及治疗策略. 国际骨科学杂志, 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. 王淑丽, 马信龙, 徐卫国, 等. 外踝骨折后三角韧带损伤程度的 X 线与 MRI 比较研究. 中华骨科杂志, 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. 杨清雅, 徐志斌, 王进. 高频三维超声对三角韧带断裂的诊断价值. 中华实用诊断与治疗杂志, 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. 王海鹏, 顾峥嵘, 刘云吉, 等. 手术治疗踝关节骨折伴三角韧带损伤的疗效观察. 中国修复重建外科杂志, 2015, 29(4): 416-419.
30. 陈宇杰, 施忠民, 李晓林, 等. 带线锚钉治疗Ⅳ度旋前-外旋踝关节骨折的初步效果. 中国修复重建外科杂志, 2009, 23(5): 577-580.
31. 朱敏, 徐永清, 丁晶, 等. 手术治疗三角韧带完全断裂的旋前外旋型踝关节骨折. 实用骨科杂志, 2015, 21(8): 699-701.
32. 曹鹏, 韩小平, 王武, 等. 带线锚钉在踝关节三角韧带损伤修复中的应用. 实用骨科杂志, 2013, 19(9): 857-858.
33. 高武长, 王英振. 切开复位内固定踝关节骨折: 联合带线锚钉修复三角韧带损伤的意义. 中国组织工程研究, 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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