Management of deltoid ligament injuries in acute ankle fracture: a systematic review
Bibliographic record
Abstract
BACKGROUND: Deltoid ligament repair (DLR) was historically a common adjunct to ankle fracture fixation; however, prevailing clinical practice is to explore the medial side of the ankle only if reduction is blocked. We performed a systematic review to determine the breadth and quality of the literature evaluating DLR in the context of ankle fractures. METHODS: We searched the MEDLINE and Embase databases in May 2020 for English-language articles evaluating DLR versus no repair or syndesmotic fixation in patients with acute ankle fractures. We used descriptive statistics to compare studies and draw conclusions. RESULTS: Of 362 articles identified, 8 (3 randomized controlled trials [RCTs] and 5 retrospective cohort studies) were included in our final analysis. Five studies compared DLR to conservative management, and 3 compared DLR to transsyndesmotic fixation. Functional outcomes were equivalent between groups. Five of the 6 studies that included radiographic outcomes showed a statistically significant decrease in the medial clear space and decreased malreduction rates postoperatively in the DLR groups. CONCLUSION: High-quality evidence guiding treatment of deltoid ligament injury in acute ankle fractures is lacking; currently available evidence appears to support DLR. Given recent increased interest in DLR and syndesmotic fixation, a comprehensive multicentre RCT is warranted. Although radiographic evidence indicates the potential benefit of DLR, further research is required to establish the superiority of DLR versus clinical equipoise.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".