JOT - 2026-04-17 - Journal Article
Deltoid Ligament Repair Does Not Improve Radiographic or Clinical Outcomes in Weber Type C Pronation-External Rotation Ankle Fractures: A Randomized Controlled Trial.
Choi JY, Yu OJ, Jung YH, Suh JS
Topics
Key Takeaway
Deltoid ligament repair in Weber C (OTA 44C) fractures produced superior talar tilt at 3 months (gravity stress: 0.6° vs 3.4°; p=0.001) but this difference resolved by 12 months with equivalent MCS and FAAM scores between groups.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This RCT asked whether deltoid ligament repair adds radiographic or clinical benefit after ORIF of Weber C pronation-external rotation ankle fractures with confirmed deltoid injury. Seventy-one patients were randomized to repair vs. no repair following lateral malleolus ORIF; posterior malleolus fixation was CT-guided in both groups. DL repair produced significantly less valgus talar tilt at 3 months on both gravity stress and valgus stress views, but all radiographic parameters and FAAM scores (89–90% ADL subscale in both groups) were equivalent at 12 months.
Key Limitation
Twelve-month follow-up cannot exclude divergence in post-traumatic osteoarthritis rates or late medial instability, which are the clinically meaningful long-term consequences of residual deltoid incompetence.
Original Abstract
OBJECTIVE
To determine the clinical utility of deltoid ligament (DL) repair in Weber type C pronation-external rotation ankle fractures.
METHODS
Design: Randomized controlled trial.
SETTING
A tertiary referral university hospital.
PATIENT SELECTION CRITERIA
Between January 2022 and August 2024, patients with Weber type C ankle fractures (OTA/AO type 44C) and DL injury were enrolled and randomly assigned to either DL repair or no repair groups after the fracture fixation strategy was established based on preoperative imaging.
OUTCOME MEASURES AND COMPARISONS
Radiographic parameters, including the medial clear space (MCS), and talar tilt (TT) were assessed on standing, gravity stress, and valgus stress views at 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Foot and Ankle Ability Measure (FAAM) scores.
RESULTS
Seventy-one patients (no repair: n=36; DL repair: n=35) completed the 12-month follow-up. Demographics and preoperative parameters were comparable between the repair and no-repair groups (all P > 0.05), including mean age (33.0 vs 33.4 years), female distribution (27.8% vs 28.6%), preoperative MCS on gravity stress view (8.6 vs 9.7mm), and preoperative TT on gravity stress view (3.8° vs 4.1°). All patients underwent lateral malleolus ORIF using anatomical plates; posterior malleoli were fixed based on CT-defined criteria (fixation rates: 72.2% vs 77.1%; P = 0.634). MCS remained comparable across all views and time points (all P > 0.05); 12-month valgus stress MCS was 3.8 ± 0.8 mm (no repair) vs 4.2 ± 1.1 mm (DL repair). At 3 months, the no repair group exhibited significantly greater valgus TT on gravity stress (3.4 ± 1.0° vs 0.6 ± 1.0°; P = 0.001) and valgus stress views (4.9 ± 1.0° vs 0.2 ± 0.7; P = 0.001). These differences resolved by 12 months (1.2 ± 0.8° vs 0.4 ± 1.2° on gravity stress view, and 1.1 ± 1.0° vs 0.3 ± 1.2 on valgus stress view; all P > 0.05). FAAM scores improved significantly over time in both groups (P < 0.05); specifically, the FAAM- activities of daily living score increased from approximately 61-63% at 3 months to 89-90% at 12 months in both groups.
CONCLUSIONS
In Weber type C fractures, DL repair provided superior early talar stability compared with no repair. While the no repair group exhibited transient valgus instability at 3 months, clinico-radiographic parameters became comparable by 12 months.
LEVEL OF EVIDENCE
Level I, randomized controlled trial.