Abstract: BACKGROUND: Ankle fracture complicated with deltoid ligament injury is clinically common, and one stage repair of deltoid ligament with internal fracture fixation has gradually become a main therapeutic method, which can significantly reduce the long-term complications of ankle joint. In recent years, new progress has been made in anatomical structure characteristics and dynamic biomechanical research of deltoid ligament, thus greatly improving repairing techniques for injury in the deep layer of deltoid ligament, but there are still some controversies.
OBJECTIVE: To explore the clinical efficacy of suture anchor and medial malleolus repair in the treatment of ankle joint fractures with the deep layer of deltoid ligament.
METHODS: A total of 56 patients with ankle joint fractures and complete fracture of the deep and superficial layer of deltoid ligament treated in Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University from January 2017 to January 2022 were selected, and they were divided into two groups according to different treatment methods in repairing the deep layer of deltoid ligament with suture anchor: suture anchor repair group (n=32) and medial malleolus repair group (n=24). The medial clear space of ankle joint and American Orthopedic Foot and Ankle Society Score of patients in the two groups were evaluated before and after operative treatment.
RESULTS AND CONCLUSION: (1) All the 56 patients finished the surgery smoothly and were followed up for more than 12 months after operation. Their ankle fracture healed, and the time for fracture healing was 8-12 weeks, with a mean of 10.5 weeks. (2) The medial clear space of ankle joint in the two groups 12 months after operation was remarkably narrower than that before operation, and the difference was statistically significant (P < 0.001). The medial clear space of ankle joint in the two groups maintained a normal range 12 months after operation, and there was no statistically significant difference between the two groups (P > 0.05). (3) The AOFAS scale of patients in the two groups 6 and 12 months after operation was obviously bigger than that before operation (P < 0.001), but there was no statistically significant difference in the American Orthopedic Foot and Ankle Society Score of patients between the two groups at corresponding time points (P > 0.05). (4) It is concluded that both suture anchor and medial malleolus repair in the treatment of injury in the deep layer of deltoid ligament can recover the medial clear space of ankle joint, effectively keep the stability of ankle, and thus achieve good clinical efficacy. 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: ">ankle fracture, deltoid ligament, suture anchor, medial malleolus repair, medial clear space