Efficacy of deltoid ligament reconstruction on the curative effect, complication and long-term prognosis in ankle fracture-dislocation with deltoid ligament injury

Objective: To investigate the clinical efficacy, complications and long-term prognosis of deltoid ligament reconstruction in the treatment of ankle fracture-dislocation with deltoid ligament injury. Methods: Forty enrolled patients with ankle fracture and deltoid ligament injury were diagnosed and treated in our hospital from May 2010 to June 2014. They were divided into control group and treatment group with 20 cases in each according to the random number table method. The patients in the control group were only treated with fracture open reduction and internal fixation, while the patients in the treatment group were treated with deltoid ligament reconstruction as well as fracture open reduction and internal fixation. After the surgery, all the patients were regularly followed up for 12 to 18 months. Meanwhile, the degree of pain (VAS score) and the incidences of complications were evaluated and recorded 3 months after the operation. At the final follow-up, the Ankle Hindfoot Scale of American Orthopaedic Foot and Ankle Society (AOFAS) was applied to evaluate the ankle recovery of patients. Results: There was no significant differences in the general information between the two groups (P>0.05). All the patients who underwent the surgery under the combined spinal-epidural anesthesia, were followed up for 12-18 months and healed with similarly duration (P>0.05). However, even though the operation time and bleeding loss of the treatment group were longer and greater than those of the control group (P=0.026, P=0.032), its hospital stay was significantly shorter than that of the control group (P=0.041). Moreover, the VAS scores after treatment were evidently decreased in both groups compared with that before the surgery (P=0.012, P=0.020), which was also apparently lower in the treatment group than that in the control group (P=0.025). Additionally, the medial clear space (MCS) of the two groups 1-year after the surgery was significantly lower than that before the surgery (P=0.010, P=0.020), which in the treatment group was obviously smaller than that in the control group (P=0.011). At the final follow-up, the AOFAS Ankle Hindfoot Scale showed that the excellent and good rate (90%) in the treatment group was considerably higher than that in the control group (60%) with significant difference (P=0.001), while the difference in the incidences of complications three months after the operation showed no statistical significance (P>0.05). Conclusion: The deltoid ligament reconstruction can promote the recovery of ankle function and alleviate pain with remarkable curative effect in the treatment of ankle fracture-dislocation with deltoid ligament injury.