Role of the Deltoid Ligament in Ankle Fractures: A Review of Function Diagnosis and Management

Aim: The purpose of this review is to provide an update on the role of the deltoid ligament in ankle fractures. Methods: A comprehensive literature review was performed to summarize the function of the deltoid, how to diagnose an injury during fracture, and the current state of clinical management. Results: The deltoid ligament complex and syndesmosis have overlapping, yet distinct biomechanical contributions to mortise stability. Deltoid ligament tears are identified in a minority, but not insignificant, amount of rotational ankle fractures. Increased medial clear space on stress radiographs remains the most common method of diagnosis, though questions remain about an ideal threshold for determining mortise instability. Clear indications have been difficult to identify with the current body of literature, as deltoid repair is frequently shown to improve radiographic outcomes without improving functional outcome measures. However, patients with signs of higher-energy injuries such as high fibula fractures, combined syndesmosis deltoid injury, or logsplitter fracture dislocations may benefit from deltoid ligament repair. Conclusion: Deltoid ligament repair in ankle fractures remains controversial. Clinical significance: Certain high-energy patterns may benefit from repair. An algorithmic approach to intraoperative stress examinations can aid in identifying incompetent structures.