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Comparative Study
. 2019 Oct 18;20(1):453.
doi: 10.1186/s12891-019-2840-5.

Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

Bohua Li  1   2 , Shanxi Wang  2 , Zhengdong Zhang  2 , Hai Yang  2 , Jun Li  2 , Qin Li  2 , Lei Liu  3
Affiliations
Comparative Study

Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

Bohua Li et al. BMC Musculoskelet Disord. .

Abstract

Background: 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.

Methods: Between 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.

Results: In 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.

Conclusions: ORIF 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.

Keywords: Ankle fracture; Deltoid ligament repair; ORIF; Supination-external rotation; Transarticular external fixation.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1
Fig. 1
Imaging studies of a 24 years patient with SER IV ankle fractures (AO/OTA classification 44-B3.1) underwent ORIF with TEF. a-c Preoperative X-rays and three-dimensional CT. d, e Preoperative MRI showing deltoid ligament injury. f, g Postoperative anteroposterior and lateral X-rays. h Postoperative appearance of the affected extremity
Fig. 2
Fig. 2
Imaging studies of a 17 years patient with SER IV ankle fractures (AO/OTA classification 44-B3.1) underwent ORIF with DLR. a-c Preoperative X-rays and three-dimensional CT. d Preoperative MRI showing deltoid ligament injury. e, f Postoperative anteroposterior and lateral X-rays
See this image and copyright information in PMC

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