* A Grade III injury represents inherent instability of the distal tibiofibular joint with complete disruption of all syndesmotic ligaments, with or without involvement of the deltoid ligament
. X-rays will be positive in Grade III syndesmotic injuries because of the complete disruption of syndesmotic ligaments.
After bony fixation, all patients in the present study were found a negative stress test, which may be due to only patients with both a SMM fracture and a potential complete deltoid ligament
being included in the study.
Tibiotalar portion of the deltoid ligament
. Note the dotted line representing the anterolateral corner of the talus that can be impinged by the distal portion of the anterior inferior tibiofibular ligament that lies over it.
Baird RA, Jackson ST 1987 Fractures of the distal part of the fibula with associated disruption of the deltoid ligament
. Treatment without repair of the deltoid ligament
Journal of Bone and Joint Surgery 69 1346-1352
Medial impingement syndrome of the anterior tibiotalar fascicle of the deltoid ligament
on the talus.
Palpate the deltoid ligament
along the base of the tibia, then move to the tarsal navicular, where the posterior tibialis comes down and inserts--that's the place to palpate for a bony avulsion fracture.
By doing so and by releasing the superficial part of deltoid ligament
, by detaching the spring ligament from sustentaculum tali and by dividing the talocalcaneal interosseous ligament and bifurcated ligament the navicular is completely mobilized and reduced onto the head of talus.
injuries: anatomy, diagnosis, and treatment.
Also important to consider is the close approximation of the posterior tibial and flexor hallucis tendons to the deltoid ligament
as their tendon sheaths are essentially contiguous with the insertions of the deltoid ligament
Release the superficial layer of deltoid ligament
from the calcaneus.
The external rotation force begins on the medial side with an injury to the deltoid ligament
or a medial malleolus fracture.
The medial ligament complex is termed the deltoid ligament
, a fan-shaped group of four ligaments comprising the anterior talotibial, calcaneotibial, tibionavicular, and posterior talotibial ligaments.
Fracture of the distal part of fibula with associated disruption of the deltoid ligament
. J Bone Joint Surg, 1987; 69A: 1346-52.
The presentation of talar fractures may vary from vague pain by which they may be missed on initial presentation to compound fractures such as Hawkin's Type III where the talus may be excruded from the joint posteromedially and wrapped around the deltoid ligament
Abduction external rotation type of injury leading to deltoid ligament
avulsion and medial malleolar fracture is reported once in 1989 by O'Leary and Ward.