Ankle fractures reduction under direct visualization. Superiority of anatomical landmarks versus radiological...

Distal tibiofibular joint injury is quite common in rotational ankle fractures, with high malreduction rates reported. Although several intraoperative techniques evaluate the optimal tibiofibular reduction, they are critically debated due to high error rates and subjective interpretation of the results. We attempted to describe specific anatomical landmarks and anatomical relationships of the ankle joint through capsulotomy and inspection of the anterior incisura fibularis corner and evaluate their reliability regarding optimal tibiofibular reduction. Sixty patients with malleolar fractures and concomitant distal tibiofibular joint disruption were randomized into two groups. Patients of Group A were treated with a standard approach. In Group B, the reduction was performed following specific anatomical landmarks of the anterolateral ankle joint through capsulotomy. Reduction quality was evaluated with postoperative bilateral ankle CT. Distal tibiofibular joint reduction after direct visualization resulted in significantly better rotation and fibula length values than patients treated with the standard approach. In addition, clinical scores were better in the 3rd and 6th postoperative months. Direct visualization of the anterolateral ankle joint can provide trustworthy anatomical landmarks to achieve high-quality reduction of the distal tibiofibular joint in ankle fractures. Additional repair of the ligamentocapsular structures of the corner enhances joint stability and provides better clinical outcomes in 12 months.