Abstract
Introduction: Rotational forces in ankle injuries can present as isolated lateral malleolus fracture with talar shift or ankle subluxation. It results in medial joint space [clear space] widening, and more than 4 mm is considered significant. The extent of medial soft tissue injury and exploration as a routine is always a debate.
Aim: To see if medial clear space widening correlate with medial soft tissue injury. Also to evaluate the out come of these fracture fixation.
Materials and Methods: Retrospective study on the management of isolated lateral malleolus fractures with significant medial clear space widening. N=40. Patient group A [25] under went only lateral side fixation and in group B [15] had additional medial side soft tissue exploration as a routine based on medial clear space widening.
Fractures were Classified based on the Weber’s system. Pre-operative medial clear space measurement was done by 2 independent observer using PACS measurement tool. Intraoperative details for the method of fixation and the medial soft tissue were analysed.
Most common method of fixation is Neutralisation plate for the lateral side. In Weber B type 1/3 rd of the cases had both plate on the lateral side and syndesmotic screw fixation. 2/3rd of them had only plate fixation.
In Webers C type, only syndesmotic screw in n=3, Plate and screw n=4, only plate in n=9 cases
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Radiological measurement of medial clear space average = 9.08mm, range= 5 –22 mm
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Less than 50% of the patients only had medial clinical signs.
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26.6% had soft tissue (periosteal injury) and only 6.6% had deltoid ligament injury Out come assessment criterias:
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The failure of fixation or any on going medial symptoms in group A. – one case of failure of fixation.
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Final clinical assessment with ankle score (Olerud and Molander score.) at 6 months average (between 3–18 months). No significant difference in the score, on follow up.
Conclusion:
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Medial clear space does not correlate with any degree of medial soft tissue injury.
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Exploration is indicated if widening persist after lateral side fixation.
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Routine exploration of the medial side has no long term impact on the clinical outcome.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
Reference:
1 Schuberth et al. Radiological widening of the medial clear space is not a reliable indicator of deep deltoid ligament injury. J Foot Ankle Surgery2004 Jan–Feb; 43(1):20–9 Google Scholar
2 De souza et al. Deltoid ligament exploration/repair – No difference in long term. Explore if ‘Talar shift’ persist on table or Inadequate reduction of fibula. JBJS [Am]1985 sep. Google Scholar
