Purpose
To evaluate the feasibility of arthroscopic reduction percutaneous fixation (ARPF)
in the treatment of isolated medial malleolar fracture and compare the results with
those of conventional open reduction internal fixation (ORIF).
Methods
This prospective study enrolled 77 patients with isolated medial malleolar fracture
between November 2011 and February 2016. The patients were assigned to the ARPF (n =
34) and ORIF (n = 43) groups. The Olerud-Molander ankle score (OMAS), ankle range
of motion (ROM), visual analog scale, and radiographic evaluation were determined
at the scheduled follow-up.
Results
In the ARPF group, 11 of 34 patients (32.4%) had chondral lesions. Tears of the deltoid
ligament and anterior inferior tibiofibular ligament were noted in 3 (8.8%) and 15
(44.1%) patients, respectively. The mean follow-up was 5 years. The mean OMAS was
higher in the ARPF group than in the ORIF group. The differences were statistically
significant at 6 months (mean ± standard deviation, 80.2 ± 4.0 for ARPF vs 77.2 ±
4.1 for ORIF, P = .005) and 1 year (92.9 ± 4.9 vs 88.1 ± 4.6, P < .001), but not at the latest follow-up (P = .081). Ankle ROM was markedly improved in the ARPF group, unlike in the ORIF group
at 6 months (dorsiflexion, P = .025; plantarflexion, P < .001) and 1 year (dorsiflexion and plantarflexion, P < .001). The improvement remained at the latest follow-up in plantarflexion (P = .001) but not in dorsiflexion (P = .354).
Conclusions
Arthroscopy-assisted reduction is a feasible alternative modality with superior short-term
outcomes for treating isolated medial malleolar fracture, but its superiority may
be attenuated in the intermediate term.
Level of Evidence
Level III, comparative study.
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Article info
Publication history
Published online: February 10, 2020
Accepted:
January 20,
2020
Received:
August 5,
2019
Footnotes
See commentary on page 1722
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Optimizing Surgical Management of Ankle Fractures: Is Arthroscopy the Answer?ArthroscopyVol. 36Issue 6
- PreviewThe surgical management of ankle fractures can be an unforgiving endeavor. Subtle malreductions in fracture fragments lead to significant deviations in joint reactive forces and, consequently, accelerated arthritis. The diagnosis of associated ligamentous pathology, such as deltoid and syndesmotic injuries, is often difficult and ideal surgical management is debated. Ankle fractures that are seemingly optimally managed using traditional surgical techniques may remain persistently painful and function poorly—a scenario that begs the question, was there more to the injury than met the eye (or radiographs)? Here, unrecognized concomitant intra-articular injuries and subtle surgical malreductions have been implicated.
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