Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes


      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 and arthroscopy.


      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 outcome.

      Level of evidence

      Level IV, therapeutic study, case series (no control group).

      Key words

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        • Van Dijk C.N.
        • Verhagen R.A.W.
        • Tol J.L.
        Arthroscopy for problems after ankle fracture.
        J Bone Joint Surg Br. 1997; 79: 280-284
        • Ferkel R.D.
        • Orwin J.F.
        Arthroscopic treatment of acute ankle fractures and postfracture defects.
        in: Ferkel R.D. Arthroscopic surgery. Lippincott-Raven, Philadelphia1996: 185-200
        • Hintermann B.
        • Regazzoni P.
        • Lampert C.
        • Gächter A.
        Arthroscopic findings in acute fractures of the ancke.
        J Bone Joint Surg Br. 2000; 82: 345-351
        • Boe S.
        Arthroscopy of the ankle joint.
        Arch Orthop Trauma Surg. 1986; 105: 285-286
        • Feder K.S.
        • Schonholts G.J.
        Ankle arthroscopy.
        Foot Ankle. 1992; 13: 382-385
        • Amendola A.
        • Petrik J.
        • Webster-Bogaert S.
        Ankle arthroscopy.
        Arthroscopy. 1996; 12: 565-573
        • Baker C.L.
        • Graham J.M.
        Current concepts in ankle arthroscopy.
        Orthopedics. 1993; 16: 1027-1035
        • Ferkel R.D.
        • Fasulo G.J.
        Arthroscopic treatment of ankle injuries.
        Orthop Clin North Am. 1994; 25: 17-32
        • Guhl J.F.
        New techniques for arthroscopic surgery of the ankle.
        Orthopedics. 1986; 9: 261-269
        • Sasaki K.
        • Nishikawa S.
        • Aizawa K.
        • Arai K.
        Arthroscopic assisted osteosynthesis for malleolar fractures of the ankle joint (In Japanese).
        Kossetsu. 1998; 20: 689-693
        • Loren G.J.
        • Ferkel R.D.
        Arthroscopic assessment of occult intra-articular injury in acute ankle fractures.
        Arthroscopy. 2002; 18: 412-421
        • Hopkinson W.J.
        • Pierre P.
        • Ryan J.B.
        • Wheeler J.H.
        Syndesmosis sprains of the ankle.
        Foot Ankle. 1990; 10: 325-330
        • Lauge-Hansen N.
        Fractures of the ankle joint.
        Arch Surg. 1948; 56: 259-317
        • Lauge-Hansen N.
        Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations.
        Arch Surg. 1950; 60: 957-985
        • Lauge-Hansen N.
        Fractures of the ankle. IV. Clinical use of genetic roentgen diagnosis and genetic reduction.
        Arch Surg. 1952; 64: 488-500
        • Burwell H.N.
        • Charnley A.D.
        The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement.
        J Bone Joint Surg Br. 1965; 47: 634-660
        • Surrento D.Z.
        • Mlodzienski A.
        Incidence of lateral talar dome lesions in SER IV ankle fractures.
        J Foot Ankle Surg. 2000; 39: 354-358
        • Meislin R.J.
        • Rose D.J.
        • Parisien S.
        • Springer S.
        Arthroscopic treatment of synovial impingement of the ankle.
        Am J Sports Med. 1993; 21: 186-189
        • Liu S.H.
        • Raskin A.
        • Osti L.
        • et al.
        Arthroscopic treatment of anterolateral ankle impingement.
        Arthroscopy. 1994; 10: 215-218
        • Thordarson D.B.
        • Bains R.
        • Shepherd L.E.
        The role of ankle arthroscopy on the surgical management of ankle fractures.
        Foot Ankle Int. 2001; 22: 123-125