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Review
. 2022 Jul 19;14(7):e27040.
doi: 10.7759/cureus.27040. eCollection 2022 Jul.

Assessing the Utility of Deltoid Ligament Repair in Ankle Fracture: A Systematic Review

Kiya Shazadeh Safavi  1 , Aryan Rezvani  2 , Cory F Janney  3 , Jie Chen  1 , Waleed Cassis  4 , Navid Darayan  5 , Vinod K Panchbhavi  1 , Daniel C Jupiter  6   1
Affiliations
Review

Assessing the Utility of Deltoid Ligament Repair in Ankle Fracture: A Systematic Review

Kiya Shazadeh Safavi et al. Cureus. .

Abstract

Ankle fractures are common injuries treated by orthopedists. Indications for operative repair of deltoid ligament (DL) injuries in ankle fracture patients are debated. The purpose of this review is to determine the indications for operative DL repair. Ovid MEDLINE, CINAHL, and Scopus were searched up to December 2019. Web of Science was searched up to August 2018. Search terms included "Deltoid" and "Ligament" or "Ligaments." Comparative studies assessing conservative vs operative DL repair were searched for. Articles meeting inclusion criteria were screened in two stages to determine eligibility. Out of 1,542 articles, nine were included in our qualitative synthesis. These nine studies included 449 patients, of which 233 were treated with open reduction internal fixation (ORIF) with or without trans-syndesmotic (TS) screw fixation, and 205 of which were treated with ORIF with DL repair. The remaining 21 patients were managed nonoperatively, had no evidence of DL injury, or were lost to follow-up. There is a lower rate of malreduction associated with DL repair compared to TS screw fixation. Moreover, DL repair may be useful in treating patients with Weber Type C fractures, concomitant DL-syndesmotic disruption, or residual valgus instability following ORIF in isolated lateral malleolar fractures.

Keywords: ankle fractures; ankle instability; deltoid; deltoid ligament; medial collateral ligament; repair; syndesmosis.

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Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. Anatomical dissection of the deltoid ligament showing (A) anterior, (B) lateral, and (C) posterior views of the deltoid ligament complex. These images are original and were created by the authors of this study.
Figure 2
Figure 2. PRISMA flow diagram showing article selection process
This figure was created using the PRISMA 2009 Flow Diagram. 1,542 papers were found. Screening based on article title and abstract, we excluded 1,444, leaving 98. Of these, 22 duplicates were excluded, leaving 76. Screening full manuscripts that discussed the DL another 67 were excluded as they were not specifically related to our topic, leaving nine to be used in our qualitative synthesis
See this image and copyright information in PMC

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