Tib/Fib fracture and deltoid tear. Ortho question

Triathlon Forum
1

First time I have seen this clinically…

Tib/Fib fracture ORIF 6/12 post. Recent MRI (1/52) revealed complete tear medial portion deltoid ligament.

What are surgical options for this?

(I posted something similar yesterday but I can not seem to find this post?)

2

Not sure of your questions and your dates are wonky :wink:

Too many variables though - assume with ORIF lateral fibular plate and medial malleolar fx with 2 screws and no syndesmosis injury? Deltoid likely ruptured at the time time of injury, but is not usually primarily repaired during ORIF sx - just assumed the associated soft tissue injury(ies) heal with the ORIF sx and immobilization.

3

6mth post sx = 6/12
1 week previous MRI occured = 1/52

Repair was sydesmosis screw, no plates, no report of deltoid tear on sx report. Recent MRI identified this. There is a known step deformity of the tibiaal articular surface as well. My question… is further surgical correction an option for the deltoid ligament.

4

That is bad if the there is a “step deformity” that I assume you referring to the medial gutter (talus to medial tibial space). This is the whole point of the syndesmotic screw to reduce this instability of the ankle joint. Again, the syndesmosis (and deltoid complex) generally heals “indirectly” when this is reduced.

It sounds like it wasn’t reduced, hence the MRI findings now. Primary repair of the Deltoid complex is difficult at best since there are 5 different ligaments, superficial and deep, and you still need to address the ankle instability.

5

rroof, pm sent.

6

6mth post sx = 6/12
1 week previous MRI occured = 1/52

Repair was sydesmosis screw, no plates, no report of deltoid tear on sx report. Recent MRI identified this. There is a known step deformity of the tibiaal articular surface as well. My question… is further surgical correction an option for the deltoid ligament.

  1. If the syndesmosis is torn, then typically the deltoid ligament is torn or there is a medial malleolar fracture as a precedent to the syndesmosis tear during the injury mechanism. There is no “need” to report the deltoid tear on the surgical report, as it is not typically surgically repaired in an injury of this sort.
  2. With regard to the tibial articular surface step deformity, are you referring to a displaced posterior malleolar component or are you referring to a lateral shift of the talus within the ankle mortise (typically with opening of the medial joint space)?
  3. If there is no lateral shift of the talus within the mortise, then it is likely that the syndesmosis is stable and there is no need for surgical attention to the deltoid ligament at this time. On the other hand, if there is lateral shift of the talus within the mortise, then the syndesmosis is perhaps not adequately repaired, and consequently, surgical revision may be in order, which may or may not involve addressing the deltoid.
7

In 1994, I had a similar injury. Syndesmosis tear, 2 tibial fractures, one involving the articular surface, a proximal fibular fracture. Oh! and the deltoid ligament was torn from the medial malleolus (tibia). This was a sliding injury, where my cleat caught and turned my whole foot around backward and left it about 100deg to the left. I got a syndesmosis screw, and tibial screw (which remains) and the deloid ligament go reattached to the malleolus. That damned deltoid repair hurt much more than all the rest combined. The pain was terrible. I still lack about 5-10 deg of plantar flexion and dorsiflexion on that (left) leg. The ortho told me I’d never be able to do much running.

When a few years ago, I told him I was competing, fairly successfully, with a strength in running, he was amused, but not entirely surprised. He told me he had done a similar repair on a few other guys who were also doing distance running, successfully.

A funny side story. When it happened, he said (at 10:30pm), "Well, you ate last at 8:00 (pm), so we could do the surgery at 2:00 (a.m.). I said, “Give me something for pain and a splint and get a good night’s sleep. I’ll see you in the morning.”