Arthroscopic versus open fixation for medial malleolus fractures improves trauma response and bone healing

Medial malleolus fracture is traditionally performed via an open approach. However, significant drawbacks such as exfoliated soft tissue injury, infection, prolonged recovery periods have been reported. Recently, arthroscopy-assisted reduction percutaneous internal fixation (ARPF) demonstrates advantages in minimizing soft tissue damage, improving joint visualization, and enhancing postoperative recovery, however, robust comparative evidence remains sparse on the efficacy of ARPF versus open reduction and internal fixation (ORIF) in treating medial malleolus fractures. The current study provides preliminary evidence suggesting the potential utility of trauma response indexes and bone metabolism markers in clinical outcomes evaluation associated with these two surgical techniques. A retrospective study was conducted on 60 patients with medial malleolus fractures from January 2021 to November 2023, The patients were divided into the ARPF (arthroscopy-assisted reduction and percutaneous internal fixation) group (n = 28) and the ORIF (open reduction and internal fixation) group (n = 32). The differences in preoperative general data, intraoperative bleeding volume, operation time, hospital stay, bone union time, and preoperative, postoperative 1 day, postoperative 3 days inflammatory response indicators [C-reactive protein (CRP), interleukin-6 (IL-6), cortisol (Cor), norepinephrine (NE)] and preoperative, postoperative 2 weeks, 4 weeks bone metabolism markers [bone carboxyglutamicacid protein (BGP), bone alkaline phosphatase (BALP), β-collagen degradation products (β-CTX)] levels, and postoperative 6 months, 1 year Olerud-Molander Ankle Score (OMAS) were compared. No significant differences were observed in age, gender, injury side, or cause of injury between the two groups (P > 0.05). Compared to the ORIF group, the ARPF group exhibited reduced intraoperative blood loss, shorter hospital stays, and accelerated bone healing time. However, the duration of surgery was significantly longer (p < 0.05). Postoperative CRP levels on days 1 and 3 were lower in the ARPF group compared to the ORIF group. Similarly, IL-6 levels on days 1 and 3 were also lower in the ARPF group. Cor levels on days 1 and 3, as well as NE levels on days 1 and 3, were both lower in the ARPF group. At weeks 2 and 4 postoperatively, BGP and BALP levels were both higher, butβ-CTX levels were lower in the ARPF group. Additionally, the OMAS scores at 6 months and 1 year postoperatively were higher in the ARPF group. Arthroscopy-assisted reduction and percutaneous internal fixation for isolated medial malleolus fracture can minimize intraoperative bleeding, reduce trauma, expedite fracture healing, enhance ankle functional recovery, making it a valuable technique for clinical application.