role of arthroscopy in the treatment of ankle fractures

ABSTRACT

Anatomic surgical realignment of ankle fractures may still be associated with poor clinical outcomes, possibly as a result of occult intra-articular injury. Malleolar fractures have been reported to be associated with a poor prognosis even when the anatomic reduction is complete. Soft tissue injuries such as damage to the cartilage and ligaments, soft tissue impingement, and the existence of free bodies within the intra-articular space account for this poor outcome. In treating acute malleolar fractures, an arthroscope is used to confirm anatomic reduction on the articular surface and treat intra-articular injuries [Leontaritis et al, 2009]. The aim of this study was to evaluate the arthroscopic findings and the surgical outcome for arthroscopy-assisted minimally invasive internal fixation of acute medial malleolar fractures. From January 2005 to December 2008, thirty two patients who had experienced medial malleolar fractures [17 males, 15 females; mean age, 35 years; range, 11-54 years] were operated on using minimally invasive surgical fixation assisted with arthroscope in the Department of Orthopedics Surgery, Al-Azhar University. Arthroscope was used to confirm the fracture line, cartilaginous damage, presence of detached cartilaginous fragments in the articular space, ligament damage, and diastasis of the distal tibiofibular joint. The cartilaginous damage was treated using shaving, and the free cartilaginous fragments were excised. Diastasis of the distal tibiofibular joint was treated using distal tibiofibular joint fixation, using a cortical screw 3.5mm Phi. Fracture fixation was conducted after anatomic reduction had been confirmed using fluoroscopy and arthroscopy. Cartilaginous damage was noted in 15 [46.8%] patients, among whoml0 patients were treated by shaving and 5 underwent cartilaginous fragment removal. From a postoperative radiographic evaluation, a good result in 28 [87.5%] patients and a fair outcome in 4 [12.5%] were confirmed. The clinical results were good in all and no postoperative complications or pseudoarthrosis was noted. The results were scored according to Freiburg Ankle Scoring System [BULGUN et al, 2004] containing the criteria pain, function, swelling, range of motion and athletic activity. The overall score significantly increased from 52.1 preoperatively to 74.8 postoperatively. Comparing the different criteria, the score parameters pain and function improved significantly, whereas the other parameters did not show significant improvements. We concluded that the arthroscopy of the ankle joint can be used in case of arthroscopic guided percutaneous fracture reduction and fixation, the procedure that shorten the recovery time, minimize the postoperative discomfort, and producing and early mobilization of the joint