Surgical outcomes of adolescent ankle fracture with deltoid ligament disruption

Objective To explore the surgical outcomes of adolescent ankle fracture with deltoid ligament disruption. Methods From January 2010 to December 2016, 21 children of adolescent ankle fractures with deltoid ligament disruption were treated. There were 12 boys and 9 girls with an average age of 14.4 (13-15.4) years. According to the Lauge-Hansen classification, there were supination-external rotation type IV (n=12), pronation-external rotation type IV (n=7) and pronation-abduction type III (n=2). Distal fibular fracture with deltoid ligament complete rupture (n=12) and distal fibular fracture, deep deltoid ligament rupture with medial malleolus fracture (n=12) were found. There were also posterior malleolus fracture (n=11) and avulsion fracture of tibial anterior tubercle (n=5). Fracture was treated by open reduction and internal fixation and all anatomic structures were completely repaired. Deltoid ligament and all ruptured ligaments were repaired simultaneously. Syndesmosis was not fixed. The mean follow-up period was 27 (12-60) months. Results Fracture line remained indistinct at week 6 postoperatively and bone union achieved at week 12 postoperatively. Based upon the Mazur’s criteria of ankle function evaluation, the outcomes were excellent (n=18) and fair (n=3). There was no postoperative occurrence of infection, nonunion, ankle instability or traumatic arthritis. Conclusions Surgical treatment of adolescent ankle fracture with disrupted deltoid ligament consists of open reduction, internal fixation of all anatomic structures and repairing deltoid ligament. And normal biomechanical environment and ankle and syndesmotic stability may be achieved for optimal ankle functional rehabilitation and satisfactory clinical outcomes. Key words: Ankle joint; Fracture; Triangular ligament