On exam, you note visible edema of the right ankle and ecchymosis over the lateral ankle, as well as moderate tenderness to palpation over the area of the ATFL and deltoid ligament
. Tenderness over the medial malleolus, lateral malleolus, fifth metatarsal, and navicular is absent.
Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures.
Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. I.
Competence of the deltoid ligament in bimalleolar ankle fractures after medial malleolar fixation.
The other important structures that were released medially are abductor hallucis, superficial part of deltoid ligament
, spring ligament, master knot of Henry and capsulotomies of subtalar, talonavicular, naviculocuneiform and cuneiformo-metatarsal joints.
In the anatomical arm of the study, cadaver ankles underwent stress testing after an isolated deltoid ligament division, isolated medial malleolus fracture, isolated division of the fibular collateral ligaments, and a short oblique distal fibula osteotomy with all ligaments intact.
Forty-six ankles, therefore, underwent operative fixation of the medial malleolus or suture repair of the deltoid ligament without fibular fixation in any of the fractures.
Criteria for inadequate reduction were set as follows: lateral malleolar displacement greater than 2 mm on the AP or lateral, medial malleolar displacement of greater than 1mm on the AP only, deltoid ligament disruption with more than 3 mm medial clear space, syndesmosis injury with tibia-fibula clear space greater than 5 mm or tibia-fibula overlap of less than 10 mm (both on the AP), or a tibia-fibula overlap of less than 1 mm on the mortise view.
Intraoperatively we noticed that there was near total avulsion of the deltoid ligament with only a few fibres of periosteum intact anteriorly.
O'Leary and Ward described a high velocity injury caused by initial abduction external rotation followed by violent adduction leading to avulsion of the deltoid ligament and fracture of the medial malleolus respectively.
The deltoid ligament provides the medial ligamentous support of the ankle.
The condition's development follows posterior tibial tendon dysfunction with several ligaments implicated in the disease including the spring and deltoid ligaments
, plantar tissues, and the talocalcaneal interosseous ligaments .