Outcomes of Deltoid Ligament Repair in Surgically Treated Weber C Ankle Fractures With Deltoid Injury: A Retrospective Comparative Study

Background: The indications for deltoid ligament (DL) repair in ankle fractures with widened medial clear space (MCS) remain controversial. Many authors report no difference in long-term functional outcomes, whereas others report persistent MCS widening and higher malreduction rates without DL repair. This study compares DL repair to no repair exclusively in surgically treated bimalleolar equivalent Weber C fibula fractures. Methods: This was a retrospective chart review of surgically treated Weber C lateral malleolus fractures with syndesmosis stabilization, with associated DL injury (bimalleolar equivalent). Patients with associated posterior or medial malleolus fractures, Weber B or A fractures, fibula fixation constructs other than plate and screws, follow-up less than 12 months, and revisions were excluded. Those meeting the inclusion criteria were split into 2 groups: DL repair vs no repair. Collected data included patient demographics, surgical procedures performed, and outcome measures. Primary outcomes measured postoperative oblique MCS and valgus talar tilt angle (TTA). Secondary outcomes included fracture union, complications, and patient-reported outcome measures (PROMs). Results: Seventy-seven fractures were included; 48 underwent DL repair whereas 29 did not. The mean follow-up was 28.9 months. Most study outcomes within each group had a statistically significant postoperative improvement. The valgus TTA in the repair vs no repair groups was 0.1 ± 0.9 vs 1.3 ± 2.0 degrees, respectively ( P < .001). The MCS in the repair vs no repair groups was 3.5 ± 0.6 vs 3.8 ± 1.3 mm, respectively ( P = .169). There were statistically significant differences in favor of DL repair in postoperative Veterans RAND-12 Item Health Survey physical subscale ( P = .025) and Foot and Ankle Ability Measure activities of daily living subscale ( P = .044) scores. There were no complications or revision surgeries directly related to DL repair. Conclusion: The DL repair group had superior functional outcomes and ankle coronal plane alignment in comparison to no repair. There were no complications or revisions related directly to the deltoid repair. These results support consideration of DL repair in bimalleolar equivalent Weber C ankle fractures to improve functional outcomes and coronal plane alignment.