Clinical and Radiographic Comparison of Lateral Malleolar Ankle Fractures Treated with or without Deltoid Fixation

Category: Ankle; Other Introduction/Purpose: There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair. Methods: This was a single-center retrospective study conducted from the institutional review board-approved Foot and Ankle Registry data, and the protocol was approved by the steering committee at the investigators’ institution. Patient-reported outcomes via PROMIS scores were collected preoperatively and at least one year postoperatively for all patients. Inclusion criteria included patients aged 18 or older who underwent open fixation for a SER IV equivalent lateral malleolar ankle fracture with a deltoid injury and had preoperative PROMIS scores. Excluded were patients without preoperative radiographs and patients with histories of previous ipsilateral ankle surgeries, rheumatoid arthritis, or gout. Retrospective review of the registry was performed, and 146 patients were included. 80 patients received a deltoid repair (DR) and 66 patients did not receive a deltoid repair (NDR). Preoperative and postoperative medial clear space (MCS) were reviewed for all patients. Results: Both DR and NDR cohorts demonstrated significant improvement in Physical Function, Pain Interference, Pain Intensity, and Global Physical Health. There were no significant differences in preoperative and postoperative PROMIS domains between the two cohorts. There were also no significant differences in preoperative MCS and postoperative MCS between the two cohorts. There were no significant differences in the incidence of subsequent procedures for removal of painful hardware, revisions, infections, progression to arthritis, and persistent pain. Conclusion: This study compares short- to medium-term patient-reported clinical outcomes and complications of lateral malleolar ankle fractures with and without deltoid repair. Repairing the deltoid did not increase the incidence of postoperative complications and produced similar PROMIS scores at 1-year minimum follow-up. This study suggests that any potential differences in outcomes between groups are not large enough to be clinically meaningful in the short term and that other factors may be more relevant in determining the best course of treatment. A longer follow-up is required to evaluate long-term functional and clinical outcomes.