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European Journal of Trauma and Emergency Surgery

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Open Access 01-12-2015 | Review Article

Osteoligamentous injuries of the medial ankle joint

Authors: P. Lötscher, T. H. Lang, L. Zwicky, B. Hintermann, M. Knupp

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2015

Abstract

Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.

Ribbans WJ, Garde A. Tibialis posterior tendon and deltoid and spring ligament injuries in the elite athlete. Foot Ankle Clin. 2013;18(2):255–91. doi:10.1016/j.fcl.2013.02.006.CrossRefPubMed

Hintermann B, Regazzoni P, Lampert C, Stutz G, Gachter A. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br. 2000;82(3):345–51.CrossRefPubMed

Hintermann B. Medial ankle instability. Foot Ankle Clin. 2003;8(4):723–38.CrossRefPubMed

Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am. 1956;38-A(4):761–81.PubMed

Lauge-Hansen N. Ligamentous ankle fractures; diagnosis and treatment. Acta Chir Scand. 1949;97(6):544–50.PubMed

Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60(5):957–85.CrossRefPubMed

Hintermann B, Boss A, Schafer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med. 2002;30(3):402–9.PubMed

Baird RA, Jackson ST. Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament. J Bone Joint Surg Am. 1987;69(9):1346–52.PubMed

Harper MC. The deltoid ligament. An evaluation of need for surgical repair. Clin Orthop Relat Res. 1988;226:156–68.PubMed

10.

Maynou C, Lesage P, Mestdagh H, Butruille Y. Is surgical treatment of deltoid ligament rupture necessary in ankle fractures? Rev Chir Orthop Reparatrice Appar Mot. 1997;83(7):652–7.PubMed

11.

Stromsoe K, Hoqevold HE, Skjeldal S, Alho A. The repair of a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Joint Surg Br. 1995;77(6):920–1.PubMed

12.

Tourne Y, Charbel A, Picard F, Montbarbon E, Saragaglia D. Surgical treatment of bi- and trimalleolar ankle fractures: should the medial collateral ligament be sutured or not? J Foot Ankle Surg. 1999;38(1):24–9.CrossRefPubMed

13.

Zeegers AV, van der Werken C. Rupture of the deltoid ligament in ankle fractures: should it be repaired? Injury. 1989;20(1):39–41.CrossRefPubMed

14.

Schuberth JM, Collman DR, Rush SM, Ford LA. Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments. J Foot Ankle Surg. 2004;43(1):20–9. doi:10.1053/j.jfas.2003.11.005.CrossRefPubMed

15.

Tornetta P 3rd. Competence of the deltoid ligament in bimalleolar ankle fractures after medial malleolar fixation. J Bone Joint Surg Am. 2000;82(6):843–8.PubMed

16.

Stufkens SA, Knupp M, Lampert C, van Dijk CN, Hintermann B. Long-term outcome after supination-external rotation type-4 fractures of the ankle. J Bone Joint Surg Br. 2009;91(12):1607–11. doi:10.1302/0301-620X.91B12.22553.CrossRefPubMed

17.

Aktas S, Kocaoglu B, Gereli A, Nalbantodlu U, Guven O. Incidence of chondral lesions of talar dome in ankle fracture types. Foot Ankle Int. 2008;29(3):287–92. doi:10.3113/FAI.2008.0287.CrossRefPubMed

18.

Lantz BA, McAndrew M, Scioli M, Fitzrandolph RL. The effect of concomitant chondral injuries accompanying operatively reduced malleolar fractures. J Orthop Trauma. 1991;5(2):125–8.CrossRefPubMed

19.

Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, et al. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am. 2002;84-A(7):1259–71.PubMed

20.

Sorrento DL, Mlodzienski A. Incidence of lateral talar dome lesions in SER IV ankle fractures. J Foot Ankle Surg. 2000;39(6):354–8.CrossRefPubMed

21.

Leontaritis N, Hinojosa L, Panchbhavi VK. Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am. 2009;91(2):333–9. doi:10.2106/JBJS.H.00584.CrossRefPubMed

22.

Hintermann B, Valderrabano V, Boss A, Trouillier HH, Dick W. Medial ankle instability: an exploratory, prospective study of fifty-two cases. Am J Sports Med. 2004;32(1):183–90.CrossRefPubMed

23.

Hermans JJ, Wentink N, Beumer A, Hop WC, Heijboer MP, Moonen AF, et al. Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI. Skelet Radiol. 2012;41(7):787–801. doi:10.1007/s00256-011-1284-2.CrossRef

24.

Nortunen S, Lepojarvi S, Savola O, Niinimaki J, Ohtonen P, Flinkkila T, et al. Stability assessment of the ankle mortise in supination-external rotation-type ankle fractures: lack of additional diagnostic value of MRI. J Bone Joint Surg Am. 2014;96(22):1855–62. doi:10.2106/JBJS.M.01533.CrossRefPubMed

25.

Hintermann B, Knupp M, Pagenstert GI. Deltoid ligament injuries: diagnosis and management. Foot Ankle Clin. 2006;11(3):625–37. doi:10.1016/j.fcl.2006.08.001.CrossRefPubMed

26.

Hintermann B, Valderrabano V. Diagnostik und Behandlung der Instabilitäten [Diagnostic and therapeutic management of ankle sprains]. Sportorthopädie Sporttraumatologie. 2001;17:153–8.

27.

Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73–94.CrossRefPubMed

28.

Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Therapy. 2006;36(6):372–84. doi:10.2519/jospt.2006.2195.CrossRef

29.

Waterman BR, Belmont PJ Jr, Cameron KL, Svoboda SJ, Alitz CJ, Owens BD. Risk factors for syndesmotic and medial ankle sprain: role of sex, sport, and level of competition. Am J Sports Med. 2011;39(5):992–8. doi:10.1177/0363546510391462.CrossRefPubMed

30.

Makwana NK, Bhowal B, Harper WM, Hui AW. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. J Bone Joint Surg Br. 2001;83(4):525–9.CrossRefPubMed

31.

Tejwani NC, McLaurin TM, Walsh M, Bhadsavle S, Koval KJ, Egol KA. Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? J Bone Joint Surg Am. 2007;89(7):1438–41. doi:10.2106/JBJS.F.01006.CrossRefPubMed

32.

Jones CR, Nunley JA 2nd. Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures. J Orthop Trauma. 2015;29(5):245–9. doi:10.1097/BOT.0000000000000220.CrossRefPubMed

Title: Osteoligamentous injuries of the medial ankle joint
Authors: P. Lötscher
T. H. Lang
L. Zwicky
B. Hintermann
M. Knupp
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2015
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-015-0548-2

At a glance: The STEP trials

Springer Medicine

Osteoligamentous injuries of the medial ankle joint

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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