Abstract
BackgroundThe topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures.MethodsBetween January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation.ResultsIn both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P < 0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2.ConclusionsORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union.
Highlights
The topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed
Suture-anchor was widely used for patients treated with deltoid ligament repair (DLR) [9,10,11], and plaster casts were most often used in treatment without DLR
Our previous study had shown that open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no DLR could achieve satisfactory outcomes in treating Supination-external rotation (SER) IV ankle fractures [15]
Summary
The topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures. Suture-anchor was widely used for patients treated with deltoid ligament repair (DLR) [9,10,11], and plaster casts were most often used in treatment without DLR. Previous studies had shown that transarticular external fixators might raplace the plaster casts well by offering the opportunity for self-healing of deltoid ligament and allowing early weight bearing [12,13,14]. Our previous study had shown that open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no DLR could achieve satisfactory outcomes in treating SER IV ankle fractures [15].
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