Outcomes at a minimum 4-year follow-up of selective deltoid ligament repair in acute ankle fracture fixation.

Abstract

The role of deltoid ligament (DL) repair in supination-external rotation (SER) type IV ankle fractures without medial malleolar fracture remains controversial. Residual medial instability may negatively affect long-term functional outcomes. This retrospective cohort study included 70 adult patients with SER type IV ankle fractures treated with fibular fixation and syndesmotic stabilization. All patients had a residual medial clear space (MCS) of 5-10 mm after syndesmotic fixation. Thirty-one patients underwent selective superficial DL repair, while 39 did not. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, Modified Olerud-Molander Score (MOMS), and Foot Function Index (FFI) at a minimum follow-up of 48 months. Multivariable logistic regression was performed to identify predictors of poor functional outcome (AOFAS <80). Baseline demographic and radiographic parameters were similar between groups. At one year postoperatively, no significant differences in functional scores were observed. At final follow-up, the DL repair group demonstrated significantly higher AOFAS (92.1 ± 8.5 vs 72.1 ± 22.0, p < 0.001) and MOMS scores (82.1 ± 15.8 vs 64.7 ± 19.8, p = 0.001). Absence of DL repair was independently associated with poor mid-term functional outcome (adjusted OR 16.4; 95% CI 3.27-82.30). Selective superficial DL repair in SER type IV ankle fractures with residual medial instability is associated with superior mid-term functional outcomes and should be considered in appropriately selected patients.