Argument against Repairing the Deltoid Ligament in Ankle Fractures

Ankle fractures are extremely common orthopedic injuries. There is evidence that the deltoid ligament becomes insufficient in the setting of acute ankle fractures. Whether this finding is clinically relevant to address with surgical repair is a topic that has been debated for years. There is literature documenting the repair or reconstruction of the deltoid ligament dating back in the 1950s, although most orthopedists have adopted the mainstay of treating the fibula fracture without directly repairing the deltoid ligament. This current standard of practice is based on the literature from the 1980s, which itself has not been revisited in the current literature. We present an argument and critique of the literature that supported not repairing the deltoid ligament in the setting of ankle fractures. The deltoid ligament has proven to confer at least some element of stability of maintaining a concentric ankle mortise. At any rate, the literature that supports not repairing the deltoid has significant limitations and needs to be investigated further to provide clarity to this difficult yet common orthopedic injury.