The Benefit of Repairing the Deltoid Ligament in Unstable Ankle Fractures

Ostfold Hospital Trust

Status: Enrolling

Conditions: Deltoid Ligament; Sprain (Strain) (Ankle); Ankle Fractures

Treatments: Procedure: Additional deep deltoid ligament suture

Study type: Interventional

Funder types: Other

Identifiers

NCT06568276

2024104

Details and patient eligibility

About

Ankle fractures occur in 1 out of 800 persons a year and is a common injury. The deltoid ligament is necessary for the stability of the joint and guides choice of treatment. Cadaveric studies have shown that deltoid ligament repair gives more stability than the osteosynthesis of the lateral malleolus itself. The investigators want to show if suture of the deltoid ligament in unstable ankle fractures contribute to a better functional result and/or prevent long term osteoarthritis for our participants. Patients sustaining severe ankle fractures have shown a considerable loss of function that might affect their long term activities of daily living (ADL) function. Improving outcome for this group may preserve some patients' ability to work and reduce community expenses.

Full description

During the last two decades less severe ankle fractures have been shown not to need operative treatment in general. The total number of ankle fracture surgeries has gone down. Therefore, surgically treated ankle fractures nowadays are on average more complex. The understanding of these injuries implies a recognition of the role of the deep deltoid ligament as a main stabilizer of the ankle joint. Deltoid ligament repair is documented to be a good option to regain ankle joint anatomy from smaller studies. This repair also compensates for syndesmotic injury to some extent. The effect of deep deltoid ligament repair in Weber B ankle fractures and its effect on long term function and arthritis is not yet known from clinical studies.

The investigators aim to show whether deltoid ligament suture gives a clinically significant superior result than solely osteosynthesis of the lateral malleolus in unstable ankle fractures. This will be performed as a multicentre randomized controlled study.

Enrollment: 120 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria; fluent in oral and written Norwegian language

• isolated Weber type B fractures and Weber B+ posterior malleolar Mason Molloy class I.
• Initial medial clear space (MCS)>=7mm or weightbearing x-ray evaluated as unstable or primary reposition after fracture dislocation.
• Pre-injury walking ability without aids.

Exclusion criteria

• assumed not compliant (drug use, cognitive- and/or psychiatric disorders).
• previous history of ipsilateral ankle fracture or ipsilateral major ankle-/foot surgery.
• open fx Gustilo Anderson II or more, multi-trauma and pathologic fracture.
• neuropathies and generalized joint disease such as Rheumatoid Arthritis or other more severe condition in same extremity
• fixation of tibial fragment or syndesmotic screw or suture button planned prior to surgery

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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120 participants in 2 patient groups

Conventional treatment

No Intervention group

Description:

Unstable Weber B fractures receiving standard treatment, plate and screw fixation of the lateral malleolus only

Additional deltoid ligament suture

Experimental group

Description:

Unstable Weber B fractures receiving standard treatment, plate and screw fixation of the lateral malleolus and additional deep deltoid ligament suture

Treatment:

Procedure: Additional deep deltoid ligament suture