Acute Deltoid Injury in Ankle Fractures: A Biomechanical Analysis of Different Repair Constructs

医学 脚踝 三角肌韧带 踝关节损伤 三角形曲线 物理医学与康复 生物力学 口腔正畸科 物理疗法 外科 解剖
作者
Emilio Wagner,Pablo Wagner,Mario I. Escudero,Florencia Pacheco,David A Salinas,Alexandre Leme Godoy‐Santos,Felipe Palma,Rodrigo Guzmán‐Venegas,Francisco José Berral de la Rosa
出处
期刊:Foot & Ankle International [SAGE]
卷期号:44 (9): 905-912 被引量:1
标识
DOI:10.1177/10711007231184844
摘要

The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model.Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling.After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling.Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes.This study helps in finding the optimum deltoid repair to use in an acute trauma setting.
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