The Incidence of Deltoid Ligament Interposition in Bimalleolar Equivalent Ankle Fractures

Category: Ankle Introduction/Purpose: When performing surgical fixation of bimalleolar equivalent ankle fractures, there has been considerable debate regarding fixation of the deltoid ligament. Many surgeons would agree that deltoid ligament repair should be undertaken if there is radiographic evidence of medial interposition of the deep deltoid. The incidence of deltoid ligament interposition has not been addressed in current literature. This study aims to assess the incidence of deltoid interposition in bimalleolar equivalent ankle fractures to provide further guidance on the importance of acute deltoid ligament repair. Methods: Over a five year time frame, 49 bimalleolar equivalent ankle fractures were repaired in 30 males and 19 females with a mean age, 37 (15-73) years. There was no exclusion criteria and patients were consecutively enrolled if they sustained a bimalleolar equivalent ankle fracture. Results: During this time frame, 49 patients who sustained a bimalleolar equivalent ankle fracture underwent surgical fixation with routine repair of the deltoid ligament. 18 patients (36.73%) had deltoid interposed within the medial gutter. 13 patients (26.53%) had an osteochondral defect. Conclusion: The incidence of deltoid interposition seen with medial exploration within this cohort was 37%. While the benefits of deltoid ligament repair are still controversial, persistent medial gutter soft tissue interposition could lead to symptoms of impingement or even result in persistent medial widening. This study supports increased scrutiny to the relationship of the medial gutter and deltoid ligament in acute bimalleolar equivalent ankle fractures.