Evaluation of Transsyndesmotic Fixation and Primary Deltoid Ligament Repair in Ankle Fractures With Suspected Combined Deltoid Ligament Injury

Kai, Wu; Lin, Jun; Huang, Jianhua; Wang, Qiugen

doi:10.1053/j.jfas.2017.12.007

Cited by 27 publications

(39 citation statements)

References 31 publications

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“…2 Traditionally, medial instability is determined by radiographic examination of the medial clear space with stress radiography, 12,13 although other forms have recently been published, such as the tap test, which may potentially address the shortcomings of the traditional forms of diagnosing medial instability. 21…”

Section: Introductionmentioning

confidence: 99%

Technique for Arthroscopic Deltoid Ligament Repair With Description of Safe Zones

Acevedo¹,

Kreulen

Cedeno³

et al. 2020

Foot Ankle Int.

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Repair of the deltoid ligaments is suggested in patients with medial ankle instability after a ligamentous injury or lateral malleolar fracture fixation. Arthroscopy can be a definitive mode of determining whether there is medial instability and, therefore, help to determine whether there is a need to repair the deltoid ligaments. The authors describe a technique for the arthroscopic repair of the deltoid ligaments, using a suture passer and suture anchors. Cadaveric analysis was utilized to establish safe zones and indicate that there is a relatively wide safe zone between the posterior tibialis tendon and the saphenous vein when performing the technique. The authors have performed more than 87 arthroscopic deltoid repairs, with a greater than 90% satisfaction rate among patients. However, future studies with validated outcome measures are needed. Level of Evidence: Level V, expert opinion.

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Section: Introductionmentioning

confidence: 99%

Technique for Arthroscopic Deltoid Ligament Repair With Description of Safe Zones

Acevedo¹,

Kreulen

Cedeno³

et al. 2020

Foot Ankle Int.

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“…Os autores concluíram que o reparo cirúrgico do LD ajuda a diminuir o ELM pós-operatório e a taxa de má redução, especialmente para fraturas do tornozelo AO tipo C. Gu et al (6) também avaliaram a diminuição do ELM para fraturas do tornozelo tratadas cirurgicamente com ou sem reparo do LD e concluíram que a reconstrução do LD desempenha um papel positivo na restauração do ECM, na cicatrização de fraturas, na melhora da função do tornozelo e na redução da dor crônica. Em 2018, Wu et al (20) relataram 59 fraturas de tornozelo com suspeita de lesão no LD e testaram a utilidade do teste/técnica intraoperatória para sindesmose tibiofibular distal e ruptura do ligamento deltóide e compararam os resultados da fixação transsindesmal com reparo do LD, incluindo âncora de sutura. Concluíram que a integridade do LD tem o importante papel não apenas na lesão da sindesmose, mas também na prevenção do alargamento do ELM.…”

Section: Discussionunclassified

“…Consistente com nossos achados, eles tiveram bons resultados funcionais e radiológicos. No entanto, eles relataram uma taxa maior de má redução e um risco maior de quebra do parafuso após a fixação sindesmótica do parafuso (20) ; em contrapartida, em nosso estudo, dois casos apresentaram parafusos sindesmóticos quebrados, mas no seguimento não houve casos de perda de redução ou mal alinhamento.…”

Section: Discussionunclassified

Comparison of deltoid ligament repair and syndesmotic fixation in malleolar fractures

et al. 2019

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Introduction: The aims were to assess residual deltoid ligament instability after lateral malleolus osteosynthesis and to compare the outcomes of deltoid suture and syndesmotic fixation. Methods: A consecutive series of 65 eligible patients with a displaced or minimally displaced fibula fracture identified on a stress radiograph were prospectively enrolled. The patients were randomized into two groups, namely, group I (deltoid repair) and group II (syndesmotic fixation). We assessed the competence of the deltoid ligament intraoperatively using a manual stress test. Only the patients with residual medial instability (Medial Clear Space greater than 4 mm) were randomly assigned for treatment by deltoid ligament repair with anchor or syndesmotic fixation. Results: Of all the patients, 60 (92.2%) had positive preoperative manual stress test results. After fracture osteosynthesis, the test results were still positive in 13 (21.6%) patients, 8 (13.3%) patients from group I, both superficial and deep layers sutured with a bone anchor, and 5 patients (8.3%) from group II, stabilized with a syndesmotic 4-cortical screw. At the end of the surgery, a new manual stress test was performed, which proved stability in all the patients. The average follow-up period was 23.5 months. In groups I and II, the AOFAS scores were 95 and 93, the EQ-5D measures were 0.758 and 0.743, the visual analogue scale (VAS) scores were 16.7 and 19.2, and the Medial Clear Space values were 2.7 ± 0.5 mm and 2.6 ± 0.4 mm, respectively, without statistically significant differences. Conclusion: In 21.6% of cases, residual medial instability persisted after osteosynthesis of the lateral malleolus. The deltoid repair and syndesmotic fixation groups showed similar functional and radiological outcomes. Level of Evidence II; Therapeutic Studies; Prospective Comparative Study.

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“…Recientemente, se han publicado varios estudios que reabren el debate sobre la indicación de reparar o no el ligamento (1,2,8) .…”

Section: A Favor De La Reparaciónunclassified

“…La tomografía computarizada (TC) postoperatoria mostró un 34,6% de mala reducción de la sindesmosis en el grupo del tornillo transindesmal, siendo solo del 9% en el caso de haber reparado con anclajes óseos el deltoideo. Esta diferencia sí era estadísticamente significativa (1) .…”

Section: A Favor De La Reparaciónunclassified

¿Qué hacer con el ligamento deltoideo?

Busquets-Net¹,

Duarri-Lladó²

2019

MACT

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Este es un artículo Open Access bajo la licencia CC BY-NC-ND (www.creativecommons.org/licenses/by-nc-nd/4.0/). FS Introducción El ligamento deltoideo (LD) es un estabilizador medial del tobillo esencial. Las lesiones del LD pueden presentarse como lesiones degenerativas, como esguinces (bien aisladas o asociadas a lesiones de otros ligamentos como la sindesmosis) o en el contexto de una fractura bimaleolar. En este apartado nos referiremos a los 2 últimos tipos. Como en otras patologías, el tratamiento de las lesiones del LD ha suscitado controversia entre el tratamiento quirúrgico o conservador (1,2) .

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Evaluation of Transsyndesmotic Fixation and Primary Deltoid Ligament Repair in Ankle Fractures With Suspected Combined Deltoid Ligament Injury

Cited by 27 publications

References 31 publications

Technique for Arthroscopic Deltoid Ligament Repair With Description of Safe Zones

Technique for Arthroscopic Deltoid Ligament Repair With Description of Safe Zones

Comparison of deltoid ligament repair and syndesmotic fixation in malleolar fractures

¿Qué hacer con el ligamento deltoideo?

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