Primary deltoid ligament repair versus trans-syndesmotic fixation for acute bimalleolar equivalent ankle fractures: A meta-analysis of comparative studies
Bibliographic record
Abstract
The indication for deltoid ligament repair in lateral malleolus fractures with associated deltoid ligament injury is controversial. The goal of this meta-analysis is to compare clinical outcomes after acute deltoid ligament repair and trans-syndesmotic screw fixation following fibula fixation for management of bimalleolar equivalent fractures. Five databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines until April 1, 2023. Primary outcomes included functional outcomes and symptomatic implant removal, while secondary outcomes included pain scores and complication rate. The Newcastle-Ottawa scale was used to check study quality. A total of 123 in the deltoid ligament repair group and 180 in the trans-syndesmotic screw fixation group were included across 5 article. Patients receiving the deltoid ligament repair technique exhibited similar American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scale scores at mean 12 months (Mean Difference (MD), 0.33; 95 % Confidence Interval (CI), −0.4 - 0.70; I2 = 0 %; P = 0.09). The symptomatic implant removal rate was lower in these patients (RR, 0.23; 95 % CI, 0.09–0.63; I2 = 9 %; P = 0.01). They likewise reported comparable visual analog scale for pain (MD = −0.03; 95 % CI, −0.39-0.34; I2 = 0 %; P = 0.8), and lower complication rates (RR, 0.26; 95 % CI, 0.10–0.69; I2 = 0 %; P = 0.01). This study highlights that acute deltoid ligament repair could be a safe and demonstrated comparable functional outcomes and pain scores to trans-syndesmotic screw fixation, while also offering the advantage of a reduced incidence of symptomatic implant removal and other complications. However, further studies that carefully control for potential confounders are necessary to validate these findings and establish a more definitive consensus for the management of bimalleolar equivalent ankle fractures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.025 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.052 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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 source (direct Gemma or distilled Codex), 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".