The applications of arthroscopy on malleolus fractures

It was well known that in 1918 Takagi performed the first arthroscopic inspection of a cadaver's knee in Japan.(1) His interest in this area laid the foundation for arthroscopy and facilitated the development of arthroscope. In 1931, Burman reported an experimental study on the arthroscopic exploration of cadaveric joints, but he believed that the ankle joint was unsuitable for such techniques because it was too narrow to pass through the posterior puncture.(2) Unexpectedly, several years later Takagi described a routine method for arthroscopic examination of the ankle.(1) Since 1970's, ankle arthroscopy had made some significant progress after almost four decades of silence. In 1972, Watanabe reported 28 cases adopting his newly-developed fiberoptic arthroscope and described the anteromedial, anterolateral and posterior approaches.(3) Then, in 1976, Chen reviewed his experience with ankle arthroscopy on 67 patients and 17 cadavers. He elaborately analyzed the various compartments within the ankle and described their anatomy in detail.(4) Subsequently, many authors reported their experiences and techniques in this field.(5-9) In 2000, Hintermann addressed his experience of the arthroscopic application in acute fractures of the ankle.(10) Meanwhile, with rich knowledge about the anatomic portals, some advanced technologies, including video camera, fiberoptic light transmission, joint distraction by invasive or non-invasive means and instruments for small joints, make it possible to perform diagnostic and operative arthroscopy in the ankle.