Journal of Foot and Ankle Surgery - 2026-04-10 - Journal Article
OUTCOMES AT A MINIMUM 4-YEAR FOLLOW-UP OF SELECTIVE DELTOID LIGAMENT REPAIR IN ACUTE ANKLE FRACTURE FIXATION.
Dünki A, Polat Ö, Birinci M, Batuhan Kaya H, Yıldız M, Çamur S, Kamil Çepni S
Topics
Key Takeaway
Selective superficial deltoid ligament repair in SER IV ankle fractures with residual medial clear space 5–10 mm after syndesmotic fixation yielded AOFAS scores of 92.1 vs 72.1 at minimum 4-year follow-up (p<0.001), with absence of repair independently predicting poor outcome (adjusted OR 16.4).
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Summary
This retrospective cohort compared functional outcomes in SER IV ankle fractures with residual medial clear space 5–10 mm after fibular fixation and syndesmotic stabilization, with 31 undergoing superficial deltoid repair and 39 not. At one year, scores were equivalent between groups; at final follow-up, the repair group had significantly higher AOFAS (92.1 vs 72.1, p<0.001) and MOMS (82.1 vs 64.7, p=0.001). Multivariable regression identified absence of deltoid repair as an independent predictor of poor outcome (adjusted OR 16.4, 95% CI 3.27–82.30).
Key Limitation
Surgeon-directed selective repair allocation in a retrospective design means unmeasured confounders—such as intraoperative tissue quality or fracture energy—likely influenced both the decision to repair and the outcome.
Original Abstract
BACKGROUND
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.
METHODS
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).
RESULTS
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).
CONCLUSION
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.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.