Role of the posterior deep deltoid ligament in ankle fracture stability: A biomechanical cadaver study  

作　　者：Daniel James McCormack Matthew Solan Sheweidin Aziz Radwane Faroug Sayyied Kirmani GeorginaWright Jitendra Mangwani 

机构地区：[1]Department of Trauma and Orthopaedics,University Hospitals of Leicester,Leicester LE15WW,United Kingdom [2]Department of Trauma and Orthopaedic Surgery,Royal Surrey City Hospital NHS Trust,University of Surrey,Guilford GU27XX,United Kingdom [3]Department of Trauma and Orthopaedics,Stoke Mandeville Hospital,Aylesbury HP218AL,Buckinghampshire,United Kingdom

出　　处：《World Journal of Orthopedics》2022年第11期969-977,共9页世界骨科杂志（英文版）

摘　　要：BACKGROUND The deltoid ligament is a key component of ankle fracture stability.Clinical tests to assess deltoid ligament injury have low specificity.In supination externalrotation(SER)type-IV ankle fractures,there is either a medial malleolus fracture or deltoid ligament injury.These injuries are often considered unstable,requiring surgical stabilisation.We look to identify the anatomical basis for this instability.This study investigates the anatomical basis for such instability by re-creating SER type ankle fractures in a standardised cadaveric study model,investigating the anatomical basis for such instability.AIM To investigate the anatomical basis for fracture instability in SER type ankle fractures.METHODS Four matched pairs of cadaveric limbs were tested for stability both when axially loaded and under external rotation stress.Four matched pairs of cadaveric limbs(8 specimens)were tested for stability when axially loaded to 750 N with a custom rig.Specimens were tested through increasing stages of SER injury in a stepwise fashion before restoring the lateral side with open reduction and internal fixation(ORIF).Clinical photographs and radiographs were recorded at each step.We defined instability in accordance with well accepted radiological parameters:>4 mm medial clear space opening on a mortise-view radiograph or>7 degrees of talar tilt.RESULTS All specimens with an intact posterior deep deltoid ligament were stable.Once the posterior deep deltoid ligament was sectioned there was instability in all specimens.Stabilisation of the lateral side prevented talar shift,but not talar tilt.CONCLUSION If the posterior deep deltoid ligament is intact then SER fractures can be managed without surgery.If the posterior deep deltoid is incompetent,ORIF and cautious rehabilitation is recommended because the talus can still tilt in the mortise.

关 键 词：TRAUMA Fracture stability BIOMECHANICS Cadaveric study Basic science 

分 类 号：R687.3[医药卫生—骨科学]