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Stufkens SA, van den Bekerom MP, Knupp M, et al. The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review. Strategies Trauma Limb Reconstr. 2012;7(2):73-85doi: 10.1007/s11751-012-0140-9.
Stufkens, S. A., van den Bekerom, M. P., Knupp, M., Hintermann, B., & van Dijk, C. N. (2012). The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review. Strategies in trauma and limb reconstruction, 7(2), 73-85. https://doi.org/10.1007/s11751-012-0140-9
Stufkens, Sjoerd A S, et al. "The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review." Strategies in trauma and limb reconstruction vol. 7,2 (2012): 73-85. doi: https://doi.org/10.1007/s11751-012-0140-9
Stufkens SA, van den Bekerom MP, Knupp M, Hintermann B, van Dijk CN. The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review. Strategies Trauma Limb Reconstr. 2012 Aug;7(2):73-85. doi: 10.1007/s11751-012-0140-9. Epub 2012 Jul 06. PMID: 22767333; PMCID: PMC3535131.
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Strategies Trauma Limb Reconstr. 2012 Aug;7(2):73-85. doi: 10.1007/s11751-012-0140-9. Epub 2012 Jul 06.

The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review.

Strategies in trauma and limb reconstruction

Sjoerd A S Stufkens, Michel P J van den Bekerom, Markus Knupp, Beat Hintermann, C Niek van Dijk

Affiliations

  1. Department of Orthopaedic Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands, [email protected].

PMID: 22767333 PMCID: PMC3535131 DOI: 10.1007/s11751-012-0140-9

Abstract

The supination-external rotation or Weber B type fracture exists as a stable and an unstable type. The unstable type has a medial malleolus fracture or deltoid ligament lesion in addition to a fibular fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial collateral integrity in cases of ankle fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a lateral malleolar fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures.

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