{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T01:27:14Z","timestamp":1783733234865,"version":"3.55.0"},"reference-count":58,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"funder":[{"DOI":"10.13039\/501100002636","name":"Inje University","doi-asserted-by":"crossref","award":["2023 Inje University research grant (no. 20230115)"],"award-info":[{"award-number":["2023 Inje University research grant (no. 20230115)"]}],"id":[{"id":"10.13039\/501100002636","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"DOI":"10.1007\/s00590-026-04786-y","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:45:53Z","timestamp":1780476353000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Operative management of supination-external rotation type trimalleolar equivalent ankle fractures: reassessing the role of deltoid ligament repair and impact of posterior malleolar fixation on postoperative syndesmotic widening"],"prefix":"10.1007","volume":"36","author":[{"given":"Jun Young","family":"Choi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oh Jun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Yong","family":"Yun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Soo","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"issue":"4","key":"4786_CR1","doi-asserted-by":"publisher","first-page":"e123","DOI":"10.1097\/BOT.0000000000001104","volume":"32","author":"AE Levack","year":"2018","unstructured":"Levack AE, Warner SJ, Gausden EB, Helfet DL, Lorich DG (2018) Comparing functional outcomes after injury-specific fixation of posterior malleolar fractures and equivalent ligamentous injuries in rotational ankle fractures. J Orthop Trauma 32(4):e123\u2013e128. https:\/\/doi.org\/10.1097\/BOT.0000000000001104","journal-title":"J Orthop Trauma"},{"key":"4786_CR2","doi-asserted-by":"publisher","first-page":"912024","DOI":"10.3389\/fsurg.2022.912024","volume":"9","author":"J Liao","year":"2022","unstructured":"Liao J, Zhang J, Ni W, Luo G (2022) A retrospective study of deltoid ligament repair versus syndesmotic fixation in lateral malleolus fracture combined with both deltoid ligament injury and inferior tibiofibular syndesmotic disruption. Front Surg 9:912024. https:\/\/doi.org\/10.3389\/fsurg.2022.912024","journal-title":"Front Surg"},{"issue":"2","key":"4786_CR3","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.injury.2010.04.006","volume":"42","author":"SA Stufkens","year":"2011","unstructured":"Stufkens SA, van den Bekerom MP, Kerkhoffs GM, Hintermann B, van Dijk CN (2011) Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature. Injury 42(2):119\u2013127. https:\/\/doi.org\/10.1016\/j.injury.2010.04.006","journal-title":"Injury"},{"issue":"3","key":"4786_CR4","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1302\/0301-620X.108B3.BJJ-2025-0491.R1","volume":"108\u2013B","author":"NR Heinz","year":"2026","unstructured":"Heinz NR, Fredrick S, Amin AK, Duckworth AD, White TO (2026) Long-term patient-reported outcomes comparing unstable ankle fractures with and without a posterior malleolus fracture. Bone Joint J 108\u2013B(3):339\u2013345. https:\/\/doi.org\/10.1302\/0301-620X.108B3.BJJ-2025-0491.R1","journal-title":"Bone Joint J"},{"issue":"1","key":"4786_CR5","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1007\/s00402-025-05959-w","volume":"145","author":"A Chidda","year":"2025","unstructured":"Chidda A, Soares S, Tannast M, Schwab J, Seidel A (2025) Long-term outcomes after a trimalleolar fracture involving the posterior malleolar fragment: an 11-year follow-up. Arch Orthop Trauma Surg 145(1):346. https:\/\/doi.org\/10.1007\/s00402-025-05959-w","journal-title":"Arch Orthop Trauma Surg"},{"issue":"4","key":"4786_CR6","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s00402-020-03645-7","volume":"142","author":"S Choi","year":"2022","unstructured":"Choi S, Choi Y, Baek E, Jo S (2022) Does repair of deltoid ligament contribute to restoring a mortise in SER type IV ankle fracture with syndesmotic diastasis? Arch Orthop Trauma Surg 142(4):535\u2013541. https:\/\/doi.org\/10.1007\/s00402-020-03645-7","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"4786_CR7","doi-asserted-by":"publisher","first-page":"247301142513308","DOI":"10.1177\/24730114251330879","volume":"10","author":"SM Hadley Jr","year":"2025","unstructured":"Hadley SM Jr, Bergman R, Peabody JJ, Westvold SJ, Filler R, Patel M et al (2025) Does deltoid ligament repair reduce complications and improve functional outcomes measured by PROMIS scores following ankle fracture surgery? Foot Ankle Orthop 10(2):24730114251330879. https:\/\/doi.org\/10.1177\/24730114251330879","journal-title":"Foot Ankle Orthop"},{"key":"4786_CR8","doi-asserted-by":"publisher","unstructured":"Jones CR, Nunley JA 2nd (2015) Deltoid ligament repair versus syndesmotic fixation in bimalleolar equivalent ankle fractures. J Orthop Trauma 29(5):245\u2013249. https:\/\/doi.org\/10.1097\/BOT.0000000000000220","DOI":"10.1097\/BOT.0000000000000220"},{"issue":"7","key":"4786_CR9","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1016\/j.injury.2016.03.017","volume":"47","author":"TH Lee","year":"2016","unstructured":"Lee TH, Jang KS, Choi GW, Jeong CD, Hong SJ, Yoon MA et al (2016) The contribution of anterior deltoid ligament to ankle stability in isolated lateral malleolar fractures. Injury 47(7):1581\u20131585. https:\/\/doi.org\/10.1016\/j.injury.2016.03.017","journal-title":"Injury"},{"issue":"1","key":"4786_CR10","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1186\/s12891-019-2840-5","volume":"20","author":"B Li","year":"2019","unstructured":"Li B, Wang S, Zhang Z, Yang H, Li J, Li Q, Liu L (2019) Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study. BMC Musculoskelet Disord 20(1):453. https:\/\/doi.org\/10.1186\/s12891-019-2840-5","journal-title":"BMC Musculoskelet Disord"},{"issue":"4","key":"4786_CR11","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1053\/j.jfas.2018.07.005","volume":"59","author":"T Li","year":"2020","unstructured":"Li T, Sun X, Li Y, Yang M, Li S, Jiang X et al (2020) Clinical study of ankle fracture combined with deltoid ligament injury: Repair or not? A retrospective, comparative study. J Foot Ankle Surg 59(4):648\u2013652. https:\/\/doi.org\/10.1053\/j.jfas.2018.07.005","journal-title":"J Foot Ankle Surg"},{"issue":"5","key":"4786_CR12","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1097\/BOT.0000000000000318","volume":"29","author":"MM Little","year":"2015","unstructured":"Little MM, Berkes MB, Schottel PC, Garner MR, Lazaro LE, Birnbaum JF et al (2015) Anatomic fixation of supination external rotation type IV equivalent ankle fractures. J Orthop Trauma 29(5):250\u2013255. https:\/\/doi.org\/10.1097\/BOT.0000000000000318","journal-title":"J Orthop Trauma"},{"issue":"1","key":"4786_CR13","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1177\/1071100720952053","volume":"42","author":"YH Park","year":"2021","unstructured":"Park YH, Jang KS, Yeo ED, Choi GW, Kim HJ (2021) Comparison of outcome of deltoid ligament repair according to location of suture anchors in rotational ankle fracture. Foot Ankle Int 42(1):62\u201368. https:\/\/doi.org\/10.1177\/1071100720952053","journal-title":"Foot Ankle Int"},{"key":"4786_CR14","doi-asserted-by":"publisher","first-page":"6313005","DOI":"10.1155\/bmri\/6313005","volume":"2025","author":"AA Pirshahid","year":"2025","unstructured":"Pirshahid AA, Brzozowski P, Sogbein O, Zdero R, Gee A, Halai M et al (2025) Biomechanical analysis of ankle stability following deltoid ligament repair and reconstruction. Biomed Res Int 2025:6313005. https:\/\/doi.org\/10.1155\/bmri\/6313005","journal-title":"Biomed Res Int"},{"issue":"5","key":"4786_CR15","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1002\/ksa.12576","volume":"33","author":"EC Sei\u00e7a","year":"2025","unstructured":"Sei\u00e7a EC, Mendes D, Sousa MR, Vide J (2025) Deltoid ligament injuries: When and how to repair. Knee Surg Sports Traumatol Arthrosc 33(5):1874\u20131883. https:\/\/doi.org\/10.1002\/ksa.12576","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"6","key":"4786_CR16","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1016\/j.fas.2021.08.007","volume":"28","author":"OA Sogbein","year":"2022","unstructured":"Sogbein OA, Yi J, Sanders DW, Lawendy AR, MacLeod M, Del Balso C (2022) Early radiographic outcomes following deltoid ligament repair in bimalleolar equivalent ankle fractures. Foot Ankle Surg 28(6):720\u2013725. https:\/\/doi.org\/10.1016\/j.fas.2021.08.007","journal-title":"Foot Ankle Surg"},{"issue":"12","key":"4786_CR17","doi-asserted-by":"publisher","first-page":"2312","DOI":"10.1016\/j.injury.2018.11.006","volume":"49","author":"X Sun","year":"2018","unstructured":"Sun X, Li T, Sun Z, Li Y, Yang M, Li S et al (2018) Does routinely repairing deltoid ligament injuries in type B ankle joint fractures influence long term outcomes? Injury 49(12):2312\u20132317. https:\/\/doi.org\/10.1016\/j.injury.2018.11.006","journal-title":"Injury"},{"issue":"9","key":"4786_CR18","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1177\/10711007231184844","volume":"44","author":"E Wagner","year":"2023","unstructured":"Wagner E, Wagner P, Escudero MI, Pacheco F, Salinas D, Godoy-Santos AL et al (2023) Acute deltoid injury in ankle fractures: a biomechanical analysis of different repair constructs. Foot Ankle Int 44(9):905\u2013912. https:\/\/doi.org\/10.1177\/10711007231184844","journal-title":"Foot Ankle Int"},{"issue":"6","key":"4786_CR19","doi-asserted-by":"publisher","first-page":"2292","DOI":"10.1016\/j.injury.2022.03.063","volume":"53","author":"KG Whitlock","year":"2022","unstructured":"Whitlock KG, LaRose M, Barber H, Fletcher A, Cunningham D, Menken L et al (2022) Deltoid ligament repair versus trans-syndesmotic fixation for bimalleolar equivalent ankle fractures. Injury 53(6):2292\u20132296. https:\/\/doi.org\/10.1016\/j.injury.2022.03.063","journal-title":"Injury"},{"issue":"1","key":"4786_CR20","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1177\/1071100717732383","volume":"39","author":"SH Woo","year":"2018","unstructured":"Woo SH, Bae SY, Chung HJ (2018) Short-term results of a ruptured deltoid ligament repair during an acute ankle fracture fixation. Foot Ankle Int 39(1):35\u201345. https:\/\/doi.org\/10.1177\/1071100717732383","journal-title":"Foot Ankle Int"},{"issue":"4","key":"4786_CR21","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1053\/j.jfas.2017.12.007","volume":"57","author":"K Wu","year":"2018","unstructured":"Wu K, Lin J, Huang J, Wang Q (2018) Evaluation of transsyndesmotic fixation and primary deltoid ligament repair in ankle fractures with suspected combined deltoid ligament injury. J Foot Ankle Surg 57(4):694\u2013700. https:\/\/doi.org\/10.1053\/j.jfas.2017.12.007","journal-title":"J Foot Ankle Surg"},{"issue":"1","key":"4786_CR22","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1186\/s12891-017-1907-4","volume":"18","author":"HM Zhao","year":"2017","unstructured":"Zhao HM, Lu J, Zhang F, Wen XD, Li Y, Hao DJ et al (2017) Surgical treatment of ankle fracture with or without deltoid ligament repair: a comparative study. BMC Musculoskelet Disord 18(1):543. https:\/\/doi.org\/10.1186\/s12891-017-1907-4","journal-title":"BMC Musculoskelet Disord"},{"issue":"6","key":"4786_CR23","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1302\/0301-620X.77B6.7593106","volume":"77","author":"K Str\u00f6ms\u00f6e","year":"1995","unstructured":"Str\u00f6ms\u00f6e K, H\u00f6qevold HE, Skjeldal S, Alho A (1995) The repair of a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Joint Surg Br 77(6):920\u2013921","journal-title":"J Bone Joint Surg Br"},{"issue":"1","key":"4786_CR24","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/0020-1383(89)90043-0","volume":"20","author":"AV Zeegers","year":"1989","unstructured":"Zeegers AV, van der Werken C (1989) Rupture of the deltoid ligament in ankle fractures: Should it be repaired? Injury 20(1):39\u201341.","journal-title":"Injury"},{"key":"4786_CR25","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1097\/01.blo.0000203489.21206.a9","volume":"447","author":"MJ Gardner","year":"2006","unstructured":"Gardner MJ, Brodsky A, Briggs SM, Nielson JH, Lorich DG (2006) Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res 447:165\u2013171. https:\/\/doi.org\/10.1097\/01.blo.0000203489.21206.a9","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"4786_CR26","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1007\/s11999-009-1111-4","volume":"468","author":"AN Miller","year":"2010","unstructured":"Miller AN, Carroll EA, Parker RJ, Helfet DL, Lorich DG (2010) Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res 468(4):1129\u20131135. https:\/\/doi.org\/10.1007\/s11999-009-1111-4","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"4786_CR27","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1053\/j.jfas.2014.09.043","volume":"54","author":"JY Choi","year":"2015","unstructured":"Choi JY, Kim JH, Ko HT, Suh JS (2015) Single oblique posterolateral approach for open reduction and internal fixation of posterior malleolar fractures with an associated lateral malleolar fracture. J Foot Ankle Surg 54(4):559\u2013564. https:\/\/doi.org\/10.1053\/j.jfas.2014.09.043","journal-title":"J Foot Ankle Surg"},{"issue":"1","key":"4786_CR28","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s13018-022-02925-9","volume":"17","author":"AM Goulart Neto","year":"2022","unstructured":"Goulart Neto AM, Maffulli N, Migliorini F, de Menezes FS, Okubo R (2022) Validation of foot and ankle ability measure (FAAM) and the foot and ankle outcome score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study. J Orthop Surg Res 17(1):38. https:\/\/doi.org\/10.1186\/s13018-022-02925-9","journal-title":"J Orthop Surg Res"},{"issue":"11","key":"4786_CR29","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1177\/107110070502601113","volume":"26","author":"RL Martin","year":"2005","unstructured":"Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM (2005) Evidence of validity for the foot and ankle ability measure (FAAM). Foot Ankle Int 26(11):968\u2013983. https:\/\/doi.org\/10.1177\/107110070502601113","journal-title":"Foot Ankle Int"},{"issue":"4","key":"4786_CR30","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1053\/j.jfas.2021.12.011","volume":"61","author":"AJ Saarinen","year":"2022","unstructured":"Saarinen AJ, Uimonen MM, Suominen EN, Sandelin H, Repo JP (2022) Structural and construct validity of the foot and ankle ability measure (FAAM) with an emphasis on pain and functionality after foot surgery: A multicenter study. J Foot Ankle Surg 61(4):872\u2013878. https:\/\/doi.org\/10.1053\/j.jfas.2021.12.011","journal-title":"J Foot Ankle Surg"},{"issue":"5","key":"4786_CR31","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1177\/1071100717750577","volume":"39","author":"J Massri-Pugin","year":"2018","unstructured":"Massri-Pugin J, Lubberts B, Vopat BG, Wolf JC, DiGiovanni CW, Guss D (2018) Role of the deltoid ligament in syndesmotic Instability. Foot Ankle Int 39(5):598\u2013603. https:\/\/doi.org\/10.1177\/1071100717750577","journal-title":"Foot Ankle Int"},{"issue":"1","key":"4786_CR32","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1053\/j.jfas.2020.02.014","volume":"60","author":"J Wang","year":"2021","unstructured":"Wang J, Stride D, Horner NS, Petrisor B, Johal H, Khan M et al (2021) The role of deltoid ligament repair in ankle fractures with syndesmotic instability: a systematic review. J Foot Ankle Surg 60(1):132\u2013139. https:\/\/doi.org\/10.1053\/j.jfas.2020.02.014","journal-title":"J Foot Ankle Surg"},{"issue":"8","key":"4786_CR33","doi-asserted-by":"publisher","first-page":"e62","DOI":"10.2106\/JBJS.M.00870","volume":"96","author":"KJ Campbell","year":"2014","unstructured":"Campbell KJ, Michalski MP, Wilson KJ, Goldsmith MT, Wijdicks CA, LaPrade RF et al (2014) The ligament anatomy of the deltoid complex of the ankle: a qualitative and quantitative anatomical study. J Bone Joint Surg Am 96(8):e62. https:\/\/doi.org\/10.2106\/JBJS.M.00870","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"4786_CR34","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/j.fas.2018.11.001","volume":"25","author":"S Dabash","year":"2019","unstructured":"Dabash S, Elabd A, Potter E, Fernandez I, Gerzina C, Thabet AM et al (2019) Adding deltoid ligament repair in ankle fracture treatment: Is it necessary? A systematic review. Foot Ankle Surg 25(6):714\u2013720. https:\/\/doi.org\/10.1016\/j.fas.2018.11.001","journal-title":"Foot Ankle Surg"},{"issue":"5","key":"4786_CR35","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s00256-014-1842-5","volume":"43","author":"MS Jeong","year":"2014","unstructured":"Jeong MS, Choi YS, Kim YJ, Kim JS, Young KW, Jung YY (2014) Deltoid ligament in acute ankle injury: MR imaging analysis. Skeletal Radiol 43(5):655\u2013663. https:\/\/doi.org\/10.1007\/s00256-014-1842-5","journal-title":"Skeletal Radiol"},{"issue":"2","key":"4786_CR36","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.fas.2023.10.010","volume":"30","author":"K Obionu","year":"2024","unstructured":"Obionu K, Palm H, Astrup Y, Lange NB, Krogsgaard MR (2024) A clinical guide to the medial ligaments of the ankle: anatomy, function, diagnosis of injuries and treatment of instability\u2014 a narrative review. Foot Ankle Surg 30(2):85\u201391. https:\/\/doi.org\/10.1016\/j.fas.2023.10.010","journal-title":"Foot Ankle Surg"},{"issue":"12","key":"4786_CR37","doi-asserted-by":"publisher","first-page":"3052","DOI":"10.1002\/ksa.12274","volume":"32","author":"J Koris","year":"2024","unstructured":"Koris J, Calder JDF, Dalmau-Pastor M, Fernandez MA, Ramasamy A (2024) Deltoid ligament injuries: a review of the anatomy, diagnosis and treatments. Knee Surg Sports Traumatol Arthrosc 32(12):3052\u20133064. https:\/\/doi.org\/10.1002\/ksa.12274","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"3","key":"4786_CR38","doi-asserted-by":"publisher","first-page":"356","DOI":"10.2106\/00004623-197658030-00010","volume":"58","author":"PL Ramsey","year":"1976","unstructured":"Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 58(3):356\u2013357","journal-title":"J Bone Joint Surg Am"},{"key":"4786_CR39","doi-asserted-by":"publisher","first-page":"2043015","DOI":"10.1155\/2020\/2043015","volume":"2020","author":"H Chen","year":"2020","unstructured":"Chen H, Yang D, Li Z, Niu J, Wang P, Li Q et al (2020) The Importance of the deep deltoid ligament repair in treating supination-external rotation stage IV ankle fracture: a comparative retrospective cohort study. Biomed Res Int 2020:2043015. https:\/\/doi.org\/10.1155\/2020\/2043015","journal-title":"Biomed Res Int"},{"issue":"11","key":"4786_CR40","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1177\/1071100715593374","volume":"36","author":"AR Hsu","year":"2015","unstructured":"Hsu AR, Lareau CR, Anderson RB (2015) Repair of acute superficial deltoid complex avulsion during ankle fracture fixation in national football league players. Foot Ankle Int 36(11):1272\u20131278. https:\/\/doi.org\/10.1177\/1071100715593374","journal-title":"Foot Ankle Int"},{"key":"4786_CR41","doi-asserted-by":"publisher","unstructured":"Rigby RB, Fleisig GS, Waldrop NE 3rd (2023) Primary deltoid repair for ankle fracture using all-suture anchors. J Foot Ankle Surg 62(4):723\u2013726. https:\/\/doi.org\/10.1053\/j.jfas.2023.03.002","DOI":"10.1053\/j.jfas.2023.03.002"},{"issue":"3","key":"4786_CR42","first-page":"387","volume":"85","author":"JJ Shen","year":"2019","unstructured":"Shen JJ, Gao YB, Huang JF, Qiu QM, Cheng L, Tong SL (2019) Suture anchors for primary deltoid ligament repair associated with acute ankle fractures. Acta Orthop Belg 85(3):387\u2013391","journal-title":"Acta Orthop Belg"},{"issue":"1","key":"4786_CR43","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1111\/os.12318","volume":"9","author":"X Wang","year":"2017","unstructured":"Wang X, Zhang C, Yin JW, Wang C, Huang JZ, Ma X et al (2017) Treatment of medial malleolus or pure deltoid ligament injury in patients with supination-external rotation type IV ankle fractures. Orthop Surg 9(1):42\u201348. https:\/\/doi.org\/10.1111\/os.12318","journal-title":"Orthop Surg"},{"issue":"2","key":"4786_CR44","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1053\/j.jfas.2014.12.013","volume":"54","author":"GR Yu","year":"2015","unstructured":"Yu GR, Zhang MZ, Aiyer A, Tang X, Xie M, Zeng LR et al (2015) Repair of the acute deltoid ligament complex rupture associated with ankle fractures: a multicenter clinical study. J Foot Ankle Surg 54(2):198\u2013202. https:\/\/doi.org\/10.1053\/j.jfas.2014.12.013","journal-title":"J Foot Ankle Surg"},{"issue":"7","key":"4786_CR45","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1177\/10711007251334085","volume":"46","author":"AF Dalen","year":"2025","unstructured":"Dalen AF, Gregersen MG, Skrede AL, Bjelland \u00d8, Hellevik AI, Myklebust T\u00c5 et al (2025) Effects of fibular plate fixation and deep posterior tibiotalar ligament repair on ankle stability in a Weber B fracture model with complete deltoid ligament sectioning. Foot Ankle Int 46(7):688\u2013696. https:\/\/doi.org\/10.1177\/10711007251334085","journal-title":"Foot Ankle Int"},{"key":"4786_CR46","doi-asserted-by":"publisher","unstructured":"D\u2019Andrea G, Colombo P, Placella G, Salini V, Alessio-Mazzola M (2025) The role of deltoid ligament repair in Weber B and C ankle fractures: a systematic review and meta-analysis of clinical, functional and radiographic results. J Foot Ankle Surg 11:S1067\u20132516. https:\/\/doi.org\/10.1053\/j.jfas.2025.06.010","DOI":"10.1053\/j.jfas.2025.06.010"},{"issue":"1","key":"4786_CR47","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.1503\/cjs.020320","volume":"65","author":"M James","year":"2022","unstructured":"James M, Dodd A (2022) Management of deltoid ligament injuries in acute ankle fracture: a systematic review. Can J Surg 65(1):E9\u2013E15. https:\/\/doi.org\/10.1503\/cjs.020320","journal-title":"Can J Surg"},{"issue":"2","key":"4786_CR48","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s00264-019-04416-9","volume":"44","author":"M Salameh","year":"2020","unstructured":"Salameh M, Alhammoud A, Alkhatib N, Attia AK, Mekhaimar MM, D\u2019Hooghe P et al (2020) Outcome of primary deltoid ligament repair in acute ankle fractures: a meta-analysis of comparative studies. Int Orthop 44(2):341\u2013347. https:\/\/doi.org\/10.1007\/s00264-019-04416-9","journal-title":"Int Orthop"},{"issue":"7","key":"4786_CR49","doi-asserted-by":"publisher","first-page":"e27040","DOI":"10.7759\/cureus.27040","volume":"14","author":"K Shazadeh Safavi","year":"2022","unstructured":"Shazadeh Safavi K, Rezvani A, Janney CF, Chen J, Cassis W, Darayan N et al (2022) Assessing the utility of deltoid ligament repair in ankle fracture: a systematic review. Cureus 14(7):e27040. https:\/\/doi.org\/10.7759\/cureus.27040","journal-title":"Cureus"},{"issue":"2","key":"4786_CR50","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.fas.2024.08.008","volume":"31","author":"O Sogard","year":"2025","unstructured":"Sogard O, McDonald J, Waters ME, Lee W (2025) The clinical outcome comparison between trans-syndesmotic fixation and anatomic deltoid ligament repair in unstable ankle fractures with medial clear space widening: a systematic review and meta-analysis. Foot Ankle Surg 31(2):95\u2013104. https:\/\/doi.org\/10.1016\/j.fas.2024.08.008","journal-title":"Foot Ankle Surg"},{"key":"4786_CR51","doi-asserted-by":"publisher","unstructured":"van den Berg J, Penning D, Baumbach S, Schepers T Repairing the deltoid ligament in ankle fractures: Is it time for a paradigm shift? Foot Ankle Spec 2025 Jan 7:19386400241307817. [Epub ahead of print] https:\/\/doi.org\/10.1177\/19386400241307817","DOI":"10.1177\/19386400241307817"},{"key":"4786_CR52","doi-asserted-by":"publisher","first-page":"976181","DOI":"10.3389\/fsurg.2023.976181","volume":"10","author":"X Yang","year":"2023","unstructured":"Yang X, Zeng J, Yang W, Dela Rosa RD, Jiang Z (2023) A meta-analysis of deltoid ligament on ankle joint fracture combining deltoid ligament injury. Front Surg 10:976181. https:\/\/doi.org\/10.3389\/fsurg.2023.976181","journal-title":"Front Surg"},{"issue":"4","key":"4786_CR53","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1177\/03635465231151448","volume":"51","author":"IK Stake","year":"2023","unstructured":"Stake IK, Bryniarski AR, Brady AW, Miles JW, Dornan GJ, Madsen JE et al (2023) Effect of posterior malleolar fixation on syndesmotic stability. Am J Sports Med 51(4):997\u20131006. https:\/\/doi.org\/10.1177\/03635465231151448","journal-title":"Am J Sports Med"},{"issue":"2","key":"4786_CR54","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1097\/00005131-200502000-00006","volume":"19","author":"B Weening","year":"2005","unstructured":"Weening B, Bhandari M (2005) Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma 19(2):102\u2013108. https:\/\/doi.org\/10.1097\/00005131-200502000-00006","journal-title":"J Orthop Trauma"},{"issue":"1","key":"4786_CR55","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-0844.R1","volume":"103\u2013B","author":"JF Kubik","year":"2021","unstructured":"Kubik JF, Rollick NC, Bear J, Diamond O, Nguyen JT, Kleeblad LJ et al (2021) Assessment of malreduction standards for the syndesmosis in bilateral CT scans of uninjured ankles. Bone Joint J 103\u2013B(1):178\u2013183. https:\/\/doi.org\/10.1302\/0301-620X.103B1.BJJ-2020-0844.R1","journal-title":"Bone Joint J"},{"issue":"12","key":"4786_CR56","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.2106\/JBJS.23.01088","volume":"107","author":"A Milstrey","year":"2025","unstructured":"Milstrey A, Gartung S, Klimek M, Wermers J, Raschke MJ, Ochman S (2025) Assessing the need for additional syndesmotic stabilization in open reduction of the posterior malleolus: a biomechanical study. J Bone Joint Surg Am 107(12):1377\u20131385. https:\/\/doi.org\/10.2106\/JBJS.23.01088","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"4786_CR57","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1007\/s12178-013-9184-9","volume":"6","author":"KJ Hunt","year":"2013","unstructured":"Hunt KJ (2013) Syndesmosis injuries. Curr Rev Musculoskelet Med 6(4):304\u2013312. https:\/\/doi.org\/10.1007\/s12178-013-9184-9","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"1","key":"4786_CR58","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1097\/BOT.0b013e31818915d9","volume":"23","author":"M Horisberger","year":"2009","unstructured":"Horisberger M, Valderrabano V, Hintermann B (2009) Posttraumatic ankle osteoarthritis after ankle-related fractures. J Orthop Trauma 23(1):60\u201367. https:\/\/doi.org\/10.1097\/BOT.0b013e31818915d9","journal-title":"J Orthop Trauma"}],"container-title":["European Journal of Orthopaedic Surgery & Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-026-04786-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00590-026-04786-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-026-04786-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:45:59Z","timestamp":1780476359000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00590-026-04786-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":58,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4786"],"URL":"https:\/\/doi.org\/10.1007\/s00590-026-04786-y","relation":{},"ISSN":["1432-1068"],"issn-type":[{"value":"1432-1068","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"assertion":[{"value":"2 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"211"}}