Bi-malleolar Equivalent Fracture Fixation : Adding deltoid ligament repair is it necessary ?

Bi-malleolar equivalent fracture is an ankle fracture, which consists of a fracture of the fibula associated with a rupture of the medial collateral ligament (MCL). To date, there is limited evidence of superior clinical outcomes with the addition of deltoid ligament repair compared to open reduction and medial fibular fixation alone. The aim of this study is to evaluate the clinical and functional results of the surgical treatment in a real world. This was a retrospective study of 20 cases of bi-malleolar equivalent fracture treated only by open reduction and internal fixation of the fibula without deltoid ligament repair, in the department of Traumatology-Orthopedics of the Mohammed VI University Hospital (Oujda-Morocco), over a period of 10 years from 2013 to 2023. This bi-malleolar fractures were studied on the basis of a descriptive radiological analysis and using the the Weber and Danis and, Lauge-Hansen classification. Outcomes were evaluated according to AOFAS score, medial clear space (MCS) correction and, pain score (VAS). 20 cases treated between January 2013 and January 2023 were included. The median follow-up was 24 months. All patients underwent ORIF without deltoid ligament repair. Clinical, radiographic, and functional outcomes, as well as complications were considered. Current literature does not provide clear indication for repair of the deltoid ligament at the time of ankle fracture repair. By comparing our functional results with those of other studies, we can conclude that deltoid ligament repair have may be some advantages for patients with high fibular fractures or in patients with concomitant syndesmotic fixation.