Abstract
BACKGROUND: Routine deltoid ligament repair (DLR) during operative management of ankle fractures remains controversial.
PURPOSE: To compare patient-reported outcomes (PROs), complications, and radiographic outcomes in patients with bimalleolar equivalent ankle fractures treated with or without DLR.
STUDY DESIGN: Retrospective cohort study.
METHODS: Adult patients who underwent operative fixation of bimalleolar equivalent ankle fractures at two level 1 trauma centers between 2010 and 2023 were retrospectively identified. The primary outcome was the Olerud-Molander Ankle Score (OMAS). Secondary outcomes included additional PROs, complications, and radiographic measurements. Multivariable logistic regression assessed the association between DLR and the odds of achieving an excellent (≥91) versus non-excellent OMAS.
RESULTS: A total of 260 patients (median age 36.4 years, 38.4% female) were included. Thirty-one (12%) patients underwent DLR and 229 (88%) did not. PROs were obtained from 92 patients (18 DLR, 74 non-repair) at a median of 7.0 years postoperatively. Median OMAS was similar between cohorts (90 vs. 90, P = 0.79). DLR was not associated with increased odds of achieving an excellent OMAS (adjusted OR 1.89, 95% CI: 0.52-7.08, P = 0.335). Secondary PROs and complications were comparable between cohorts. Radiographic measurements in 111 patients (26 DLR, 85 non-repair) revealed a decreased median tibiofibular clear space in the DLR group (4.50 mm vs. 5.09 mm, P = 0.012). Medial clear space and tibiofibular overlap were similar between cohorts.
CONCLUSION: Patients with bimalleolar equivalent ankle fractures had comparable long-term PROs and complication rates regardless of DLR. Radiographic findings suggested adequate restoration of ankle joint congruity and medial stability in both cohorts.