PT  - JOURNAL ARTICLE
AU  - Michael James
AU  - Andrew Dodd
TI  - Management of deltoid ligament injuries in acute ankle fracture: a systematic review
AID  - 10.1503/cjs.020320
DP  - 2022 Jan 11
TA  - Canadian Journal of Surgery
PG  - E9--E15
VI  - 65
IP  - 1
4099  - http://canjsurg.ca/content/65/1/E9.short
4100  - http://canjsurg.ca/content/65/1/E9.full
SO  - CAN J SURG2022 Jan 11; 65
AB  - Background: Deltoid ligament repair (DLR) was historically a common adjunct to ankle fracture fixation; however, prevailing clinical practice is to explore the medial side of the ankle only if reduction is blocked. We performed a systematic review to determine the breadth and quality of the literature evaluating DLR in the context of ankle fractures.Methods: We searched the MEDLINE and Embase databases in May 2020 for English-language articles evaluating DLR versus no repair or syndesmotic fixation in patients with acute ankle fractures. We used descriptive statistics to compare studies and draw conclusions.Results: Of 362 articles identified, 8 (3 randomized controlled trials [RCTs] and 5 retrospective cohort studies) were included in our final analysis. Five studies compared DLR to conservative management, and 3 compared DLR to transsyndesmotic fixation. Functional outcomes were equivalent between groups. Five of the 6 studies that included radiographic outcomes showed a statistically significant decrease in the medial clear space and decreased malreduction rates postoperatively in the DLR groups.Conclusion: High-quality evidence guiding treatment of deltoid ligament injury in acute ankle fractures is lacking; currently available evidence appears to support DLR. Given recent increased interest in DLR and syndesmotic fixation, a comprehensive multicentre RCT is warranted. Although radiographic evidence indicates the potential benefit of DLR, further research is required to establish the superiority of DLR versus clinical equipoise.