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 fresh
malleolar fractures, an arthroscope is used at our institution to confirm anatomic
reduction on the articular surface and treat intra-articular injuries. This study
evaluated the arthroscopic findings and surgical outcome for fresh malleolar fractures.
Type of study
Prospective case study.
The subjects were 105 patients (105 joints) who had experienced malleolar fractures
and had undergone surgical fixation between January 1996 and May 1999. Arthroscopy
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 screw. Fracture
fixation was conducted after anatomic reduction had been confirmed using fluoroscopy
Cartilaginous damage was noted in 21 patients, among whom 13 were treated by shaving
and 8 underwent cartilaginous fragment removal. Fixation of the distal tibiofibular
joint was conducted in 8 patients. From a postoperative radiographic evaluation, a
good result in 100 cases and a fair outcome in 5 were confirmed. The clinical results
were good in all, and no postoperative complications or pseudoarthrosis were noted.
The use of an arthroscope during treatment of malleolar fractures enables diagnosis
and treatment of the lesions within the ankle joint, producing a satisfactory surgical
Level of evidence
Level IV, therapeutic study, case series (no control group).