Outcomes Following Ankle Fracture Fixation With or Without Ankle Arthroscopy

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Traumatology

Background:

• Ankle fractures are common orthopedic injuries with a high rate of satisfactory outcomes after surgical fixation.
• Persistent pain can occur despite anatomic reduction, with intra-articular injuries being a potential contributing factor.
• The clinical impact of incorporating ankle arthroscopy during open reduction and internal fixation (ORIF) for ankle fractures requires assessment.

Purpose of the Study:

• To evaluate the clinical impact of performing ankle arthroscopy concurrently with ORIF for bimalleolar or trimalleolar ankle fractures.
• To compare patient-reported outcomes and satisfaction rates between ORIF alone and ORIF with arthroscopy.

Main Methods:

• Retrospective chart review of 213 patients (2014-2018) with bimalleolar or trimalleolar ankle fractures undergoing operative fixation.
• Data collected included demographics, fracture patterns, operative procedures (ORIF vs. ORIF plus arthroscopy), tourniquet times, and arthroscopic findings.
• A phone and e-mail survey assessed outcomes, achieving a 50.7% follow-up rate at an average of 32.4 months.

Main Results:

• The arthroscopy group experienced a 10-minute longer average tourniquet time (89 vs. 79 minutes).
• Arthroscopy revealed significant rates of intra-articular pathology: 28% osteochondral lesions, 33% loose bodies, and 49% cartilage injury.
• Weber B fibula fractures treated with arthroscopy showed higher Patient Reported Outcome Information System (PROMIS) physical function scores (45.8 vs. 42.3, P=.012) and patient satisfaction (93% vs. 75%, P=.05).
• Patients with tibiotalar joint dislocation treated with arthroscopy had significantly higher PROMIS scores (46.6 vs. 40.2, P=.005).

Conclusions:

• Ankle arthroscopy performed during ORIF for ankle fractures leads to statistically significant improvements in patient-reported outcomes for Weber B fibula fractures and ankle dislocations.
• The addition of arthroscopy did not increase complication rates.
• The average operative time increased by only 10 minutes with the inclusion of arthroscopy.