The Benefit of Repairing the Deltoid Ligament in Unstable Ankle Fractures

NCT ID: NCT06568276

Last Updated: 2025-08-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-09-20

Study Completion Date

2032-07-01

Brief Summary

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Ankle fractures occur in 1 out of 800 persons a year and is a common injury. The deltoid ligament is necessary for the stability of the joint and guides choice of treatment. Cadaveric studies have shown that deltoid ligament repair gives more stability than the osteosynthesis of the lateral malleolus itself. The investigators want to show if suture of the deltoid ligament in unstable ankle fractures contribute to a better functional result and/or prevent long term osteoarthritis for our participants. Patients sustaining severe ankle fractures have shown a considerable loss of function that might affect their long term activities of daily living (ADL) function. Improving outcome for this group may preserve some patients' ability to work and reduce community expenses.

Detailed Description

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During the last two decades less severe ankle fractures have been shown not to need operative treatment in general. The total number of ankle fracture surgeries has gone down. Therefore, surgically treated ankle fractures nowadays are on average more complex. The understanding of these injuries implies a recognition of the role of the deep deltoid ligament as a main stabilizer of the ankle joint. Deltoid ligament repair is documented to be a good option to regain ankle joint anatomy from smaller studies. This repair also compensates for syndesmotic injury to some extent. The effect of deep deltoid ligament repair in Weber B ankle fractures and its effect on long term function and arthritis is not yet known from clinical studies.

The investigators aim to show whether deltoid ligament suture gives a clinically significant superior result than solely osteosynthesis of the lateral malleolus in unstable ankle fractures. This will be performed as a multicentre randomized controlled study.

Conditions

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Ankle Fractures Deltoid Ligament; Sprain (Strain) (Ankle)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Multicentre Randomized Controlled Trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Conventional treatment

Unstable Weber B fractures receiving standard treatment, plate and screw fixation of the lateral malleolus only

Group Type NO_INTERVENTION

No interventions assigned to this group

Additional deltoid ligament suture

Unstable Weber B fractures receiving standard treatment, plate and screw fixation of the lateral malleolus and additional deep deltoid ligament suture

Group Type EXPERIMENTAL

Additional deep deltoid ligament suture

Intervention Type PROCEDURE

The deep deltoid ligament will be sutured through a curved incision lifting the tibialis posterior tendon out to be sutured back after tying the ligament to an anchor in the talus.

Interventions

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Additional deep deltoid ligament suture

The deep deltoid ligament will be sutured through a curved incision lifting the tibialis posterior tendon out to be sutured back after tying the ligament to an anchor in the talus.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* isolated Weber type B fractures and Weber B+ posterior malleolar Mason Molloy class I.
* Initial medial clear space (MCS)\>=7mm or weightbearing x-ray evaluated as unstable or primary reposition after fracture dislocation.
* Pre-injury walking ability without aids.

Exclusion Criteria

* assumed not compliant (drug use, cognitive- and/or psychiatric disorders).
* previous history of ipsilateral ankle fracture or ipsilateral major ankle-/foot surgery.
* open fx Gustilo Anderson II or more, multi-trauma and pathologic fracture.
* neuropathies and generalized joint disease such as Rheumatoid Arthritis or other more severe condition in same extremity
* fixation of tibial fragment or syndesmotic screw or suture button planned prior to surgery
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sykehuset Innlandet HF

OTHER

Sponsor Role collaborator

Helse Nord-Trøndelag HF

OTHER

Sponsor Role collaborator

Helse-Bergen HF

OTHER

Sponsor Role collaborator

Norwegian Institute of Public Health

OTHER_GOV

Sponsor Role collaborator

Helse Stavanger HF

OTHER_GOV

Sponsor Role collaborator

Trondheim University Hospital

OTHER

Sponsor Role collaborator

Norwegian University of Science and Technology

OTHER

Sponsor Role collaborator

Alesund Hospital

OTHER

Sponsor Role collaborator

Nordlandssykehuset HF

OTHER

Sponsor Role collaborator

Ostfold Hospital Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Frede Jon Frihagen, MD, PhD

Role: STUDY_DIRECTOR

Oestfold Hospital Trust

Locations

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Oestfold Hospital Trust

Grålum, Postbox 300, Norway

Site Status RECRUITING

Ålesund Sjukhehus

Ålesund, , Norway

Site Status RECRUITING

Haukeland University Hospital

Bergen, , Norway

Site Status RECRUITING

Nordlandssykehuset Bodø

Bodø, , Norway

Site Status RECRUITING

Sykehuset Innlandet Elverum

Elverum, , Norway

Site Status RECRUITING

Sykehuset Innlandet Gjøvik

Gjøvik, , Norway

Site Status RECRUITING

Sykehuset Levanger

Levanger, , Norway

Site Status RECRUITING

Oslo University Hospital Ullevål/Aker

Oslo, , Norway

Site Status RECRUITING

Stavanger University Hospital

Stavanger, , Norway

Site Status RECRUITING

Countries

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Norway

Central Contacts

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Esten Konstad Haanæs, MD

Role: CONTACT

+4799789013

Marius Molund, MD, PhD

Role: CONTACT

+4790093988

Facility Contacts

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Frede Jon Frihagen, MD, PhD

Role: primary

Petter Pettersen, MD

Role: backup

Jakup Andreas Thomsen, MD

Role: primary

Ingrid Rieve Kristiansen, MD

Role: backup

Aleksander Uchermann, MD

Role: primary

95978404 ext. +47

Jostein Skorpa Nilsen, MD

Role: backup

Jonas Larsen Hilmo, MD

Role: primary

Ove Talsnes, MD, PhD

Role: primary

Henrik E. W. Pettersen, MD

Role: primary

+4799402322

Esten Konstad Haanæs, MD

Role: primary

Geir Steinstad, MD

Role: backup

Carl Erik Alm

Role: primary

+4799298431

Aksel Paulsen, MD PhD

Role: primary

98047438 ext. +47

Kristianne Gjengedal, MD

Role: backup

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan: Study protocol general august 2024

View Document

Document Type: Study Protocol and Statistical Analysis Plan: Study protocol update january 2025

View Document

Other Identifiers

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2024104

Identifier Type: -

Identifier Source: org_study_id

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