Bimalleolar Equivalent Fractures (BEF): Skip the Deltoid Repair?

by Vince Vacketta, DPM

Is direct deltoid ligament repair necessary for BEF, and does such a repair improve patient outcomes? 

This inquiry was the focus of a bi-centric case-control study that sought to shed light on the necessity and efficacy of systematic deltoid ligament repair in these specific ankle fractures.

Study overview

The study involved 67 adults with BEF, divided into two groups:

• 38 patients in the conservative group who did not receive ligament repair

• 29 patients in the suture repair group who underwent direct repair

Researchers assessed both radiographic and clinical outcomes to evaluate the effectiveness of the repair strategy:

• Radiographically, both groups demonstrated equivalent outcomes in medial clear space and tibio-fibular clear space reduction at the three-month follow-up.

• Clinically, the conservative group had a clear advantage, with patients returning to weight-bearing activities earlier, showing significantly higher rates by day 45 (p=0.005). They also returned to pre-injury activities sooner (p=0.0049) and reported less ankle instability (p=0.0038) than those in the suture repair group.

Plot twist

In patients with associated syndesmotic injuries, outcomes were similar, regardless of the repair strategy.

The bottom line

Opting not to perform repair results in equivalent radiologic outcomes and superior early clinical recovery compared to direct repair.