Study Summary

60 patients with acute ankle fractures associated with syndesmotic instability and deltoid ligament rupture were randomized to receive deltoid ligament augmentation (DLA) or trans-syndesmotic screw fixation (TSSF). The primary outcome of interest was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score at 1 year after surgery. Secondary outcomes included Philips and Schwartz ankle scores, 36 question short form (SF-36) quality-of-life measures, ankle range of motion (ROM), time to partial and full weight-bearing, return to work, return to preinjury-level play, radiographic outcomes, and complications. Outcomes were assessed throughout a 1-year follow-up period. Overall, the results of the study revealed that DLA achieved comparable 1-year functional and radiographic outcomes to TSSF while significantly accelerating early postoperative recovery and return to activity. These findings suggest that DLA may represent an effective alternative to syndesmotic screw fixation for ankle fractures with concomitant deltoid ligament rupture and syndesmotic diastasis.