RT Journal Article
T1 Acute deltoid injury in ankle fractures: a biomechanical analysis of different repair constructs
A1 Wagner, Emilio
A1 Wagner, Pablo
A1 Escudero, Mario I.
A1 Pacheco, Florencia
A1 Salinas, David
A1 Leme Godoy-Santos, Alexandre
A1 Palma, Felipe
A1 Guzmán-Venegas, Rodrigo
A1 Berral de la Rosa, Francisco José
K1 Deltoid ligament
K1 Deltoid repair
K1 Biomechanics
K1 Ankle fractures
K1 Cadaveric study
AB Background:The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model.Methods:Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling.Results:After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling.Conclusion:Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes.Clinical Relevance:This study helps in finding the optimum deltoid repair to use in an acute trauma setting.
PB Sage
YR 2023
FD 2023
LK https://hdl.handle.net/10433/19438
UL https://hdl.handle.net/10433/19438
LA en
NO Wagner E, Wagner P, Escudero MI, Pacheco F, Salinas D, Godoy-Santos AL, Palma F, Guzmán-Venegas R, Berral-de la Rosa FJ. Acute deltoid injury in ankle fractures: a biomechanical analysis of different repair constructs. Foot & Ankle International (Foot Ankle Int.) Sep. 2023; 44(9):905-912. ISSN: 1071-1007 EISSN 1944-7876 https://doi.org/10.1177/10711007231184844
NO Resolución de subvención de investigación para el desarrollo y fabricación de dispositivos médicos implantables para el tratamiento de enfermedades, trastornos y lesiones del pie y el tobillo, concedida por la Empresa Paragon 28, Inc. con sede en Englewood, Colorado, EEUU, empresa líder en dispositivos médicos enfocada exclusivamente en el mercado ortopédico de pie y tobillo. Convocatoria 2021.*PROYECTO:"ACUTE MEDIAL ANKLE INSTABILITY – HOW TO RECONSTRUCT?. A BIOMECHANICAL ANALYSIS".Institución/Empresa que conceden la subvención:PARAGON Inc. (EEUU). Nº ref. 529776-v1A.Subvención: 10.250 dólares. Cantidad destinada a analizar si en un modelo cadavérico con daño experimental de los ligamentos del tobillo, sometido a cargas axiales y rotacionales, es posible restablecer la estabilidad articular del tobillo mediante la reparación de los ligamentos mediales.Centros de Ejecución: Clínica Alemana y Universidad de los Andes, LIBFE. Santiago de Chile.Periodo de Ejecución: 16 de junio de 2021 al 31 de mayo de 2022.Investigador principal: Lcdo. D. Emilio Wagner HitscheldInvestigadores: Lcdo. D. Pablo Wagner HitschfeldLcdo. D. Felipe Palma TraroDr. D. Rodrigo Guzmán VenegasDr. D. Francisco José Berral de la RosaTotal de investigadores: 5
NO Universidad Pablo de Olavide. Departamento de Deporte e Informática
DS RIO
RD May 22, 2026