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Follow-up Evaluation of Medial Clear Space and Talar Tilt After Bimalleolar Equivalent Fracture Fixation Without Primary Deltoid Repair

Dalton Ryba DPM, Jordan Ernst DPM, MS, Somer Blair PhD, and Travis A. Motley DPM, MS
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Background

We sought first to determine the efficacy of lateral ankle fixation alone in maintenance of medial clear space and talar valgus in bimalleolar equivalent ankle fractures not receiving primary deltoid repair, and second to assess perceived outcomes via the Foot and Ankle Outcome Score. To our knowledge, no study has quantified the reduction of medial clear space and talar valgus in bimalleolar equivalent ankle fractures receiving lateral ankle fixation alone.

Methods

We compared preoperative, initial postoperative, and greater than 1-year follow-up radiographs of medial clear space and talar valgus in individuals who received lateral ankle fixation alone in bimalleolar equivalent ankle fractures. Subjective outcomes were measured via the Foot and Ankle Outcome Score.

Results

Thirty-seven patients participated in the study and showed a statistically significant reduction of medial clear space and restoration of talar position, and maintenance with this fixation method during follow-up in patients with bimalleolar equivalent ankle fractures. Adjunctively, patients perceived their outcomes to be satisfactory, as demonstrated by the results of the Foot and Ankle Outcome Score.

Conclusions

We aimed to assess the efficacy of lateral ankle fixation in the maintenance of medial clear space and talar valgus reduction at midterm follow-up. Although some authors contend that primary deltoid repair in bimalleolar equivalent ankle fractures is warranted, these midterm study results suggest that isolated lateral ankle fixation is adequate for medial ankle stabilization in bimalleolar equivalent fractures, and thus primary deltoid repair is not indicated.

Department of Orthopedics, John Peter Smith Hospital, Fort Worth, TX. Dr. Ryba is now with Lone Star Orthopaedics & Spine Specialists, PLLC, Fort Worth, TX.

Foot and Ankle Deformity Correction, Paley Orthopedic & Spine Institute, West Palm Beach, FL. Dr. Ernst is now with Texas Institute of Orthopedic Surgery & Sports Medicine, Grapevine, TX.

Office of Clinical Research, John Peter Smith Hospital, Fort Worth, TX.

Podiatric Surgical Residency Program, John Peter Smith Hospital, Fort Worth, TX.

Corresponding author: Dalton Ryba, DPM, Lone Star Orthopaedics & Spine Specialists, PLLC, 929 Lipscomb St, Fort Worth, TX 76104. (E-mail: dalton.m.ryba@gmail.com)