Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair

Background: There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair....

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Main Authors: Saanchi Kukadia BA, David Cho BA, Stephanie Eble MD, Prashanth Kumar BA, Alan Shamrock MD, Mark Drakos MD
Format: Article
Language:English
Published: SAGE Publishing 2025-04-01
Series:Foot & Ankle Orthopaedics
Online Access:https://doi.org/10.1177/24730114251329333
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author Saanchi Kukadia BA
David Cho BA
Stephanie Eble MD
Prashanth Kumar BA
Alan Shamrock MD
Mark Drakos MD
author_facet Saanchi Kukadia BA
David Cho BA
Stephanie Eble MD
Prashanth Kumar BA
Alan Shamrock MD
Mark Drakos MD
author_sort Saanchi Kukadia BA
collection DOAJ
description Background: There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair. Methods: This was a single-center retrospective study involving 13 surgeons. Inclusion criteria were patients aged 18 years or older who underwent open fixation for a supination external rotation type IV (SER IV) equivalent ankle fracture. SER IV fractures were confirmed with stress radiographs. Deltoid injury was confirmed with an intraoperative external rotation stress test. A total of 146 patients were included. Eighty patients received a deltoid repair (DR), and 66 patients did not receive a deltoid repair (NDR). Patient-reported outcomes via PROMIS scores were collected preoperatively and at least 1 year postoperatively for all patients. Preoperative and postoperative medial clear space (MCS) were reviewed for all patients. Results: There were no significant differences in preoperative and postoperative PROMIS domains between the 2 cohorts. There were also no significant differences in preoperative MCS and postoperative MCS between the 2 cohorts. There were no significant differences in the incidence of subsequent procedures for removal of painful hardware, revisions, infections, progression to arthritis, and persistent pain. Conclusion: This study compares short- to medium-term outcomes and complications of SER IV–equivalent ankle fractures with and without deltoid repair. No significant differences between PROMIS scores, postoperative MCS, and complication rates were observed between groups. Level of Evidence: Level III, retrospective case control study.
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spelling doaj-art-ad63f8cdd4524068bd2e51d7459c14d02025-08-20T02:19:47ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142025-04-011010.1177/24730114251329333Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid RepairSaanchi Kukadia BA0David Cho BA1Stephanie Eble MD2Prashanth Kumar BA3Alan Shamrock MD4Mark Drakos MD5Hospital for Special Surgery, New York, NY, USAHospital for Special Surgery, New York, NY, USAHospital for Special Surgery, New York, NY, USAHospital for Special Surgery, New York, NY, USAHospital for Special Surgery, New York, NY, USAHospital for Special Surgery, New York, NY, USABackground: There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair. Methods: This was a single-center retrospective study involving 13 surgeons. Inclusion criteria were patients aged 18 years or older who underwent open fixation for a supination external rotation type IV (SER IV) equivalent ankle fracture. SER IV fractures were confirmed with stress radiographs. Deltoid injury was confirmed with an intraoperative external rotation stress test. A total of 146 patients were included. Eighty patients received a deltoid repair (DR), and 66 patients did not receive a deltoid repair (NDR). Patient-reported outcomes via PROMIS scores were collected preoperatively and at least 1 year postoperatively for all patients. Preoperative and postoperative medial clear space (MCS) were reviewed for all patients. Results: There were no significant differences in preoperative and postoperative PROMIS domains between the 2 cohorts. There were also no significant differences in preoperative MCS and postoperative MCS between the 2 cohorts. There were no significant differences in the incidence of subsequent procedures for removal of painful hardware, revisions, infections, progression to arthritis, and persistent pain. Conclusion: This study compares short- to medium-term outcomes and complications of SER IV–equivalent ankle fractures with and without deltoid repair. No significant differences between PROMIS scores, postoperative MCS, and complication rates were observed between groups. Level of Evidence: Level III, retrospective case control study.https://doi.org/10.1177/24730114251329333
spellingShingle Saanchi Kukadia BA
David Cho BA
Stephanie Eble MD
Prashanth Kumar BA
Alan Shamrock MD
Mark Drakos MD
Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair
Foot & Ankle Orthopaedics
title Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair
title_full Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair
title_fullStr Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair
title_full_unstemmed Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair
title_short Comparison of Clinical and Radiographic Outcomes of Supination External Rotation Type IV Equivalent Ankle Fractures With and Without Deltoid Repair
title_sort comparison of clinical and radiographic outcomes of supination external rotation type iv equivalent ankle fractures with and without deltoid repair
url https://doi.org/10.1177/24730114251329333
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