Arthroscopically assisted versus open reduction internal fixation for ankle fractures: a systematic review and meta-analysis

Abstract

Background Open reduction and internal fixation were routinely used to treat patients with unstable ankle fractures (ORIF). However, some patients may experience persistent ankle pain and disability following ORIF due to untreated intra-articular lesions. Moreover, ankle fractures may be treated with arthroscopically assisted reduction and internal fixation (ARIF). This study aimed to compare the feasibility and benefits of ARIF versus ORIF for ankle fractures. Methods We performed this meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted for comparative studies comparing ARIF and ORIF for ankle fractures. Nine studies were included in the analysis of clinical and secondary outcomes. In summary, we calculated the mean difference (MD), risk ratio (RR), confidence interval, and p value. Results This meta-analysis demonstrated that the ARIF group achieved a higher Olerud–Molander Ankle (OMA) score (MD: 6.6; 95% CI 0.20 to 13.0; p = 0.04) and lower visual analog scale (VAS) score (MD: − 0.36; 95% CI − 0.64 to − 0.10; p = 0.01) at the final follow-up. Nevertheless, the smallest treatment effect of OMA score and VAS score did not exceed the minimum clinically important difference (MCID). There were longer surgery time (MD: 15.0; 95% CI 10.7 to 19.3; p < 0.01) and lower complication rates (RR: 0.53; 95% CI 0.31 to 0.89; p = 0.02) in ARIF compared with ORIF. The random-effect model suggested no significant difference in the arthritis change rate between the two groups. Conclusion In summary, the results of this meta-analysis indicated that ARIF and ORIF are comparable in terms of providing pain relief and improving function for patients with ankle fractures. Therefore, the choice between the two techniques should be based on the patient's individual factors and the surgeon's personal preference.

Posterior Ankle and Hindfoot Arthroscopy: A Contemporary Review

“…75 PASTA provides safe, reliable, and minimally invasive access, superior visualization of the posterior talocalcaneal facet, easy screw fixation, less postoperative pain, and preservation of calcaneal/talar blood supply. 38,83 Fusion rates with this technique range from 91% to 100%. 4,15,39,61,68,69 Moreover, PASTA obviates the need for an incision and extensive dissection to access the subtalar joint.…”

“…8,9,11,33,56,66,75 Additionally, there is evidence to support this approach for more simple fracture patterns without significant soft tissue damage; however, more complex fractures may be more optimally treated with open reduction and internal fixation (ORIF). 83 Posterior ankle impingement syndrome (PAIS) is a spectrum of disorders characterized by posterior ankle pain during plantarflexion or hyperflexion caused by overuse or trauma. Anatomic causes of PAIS include os trigonum displacement, hypertrophic posterior talar process, thickened posterior joint capsule, or osteophytes at the posterior distal tibia.…”

“…8,9,11,33,56,66,75 Additionally, there is evidence to support this approach for more simple fracture patterns without significant soft tissue damage; however, more complex fractures may be more optimally treated with open reduction and internal fixation (ORIF). 83…”

“…44 The os trigonum may become symptomatic and cause chronic or acute pain, especially in cases with repetitive plantarflexion or concurrent FHL pathology. 83,84 Clinical presentation includes tenderness and load-dependent pain between the Achilles and peroneal tendons as well as reduced plantarflexion (known as the “nutcracker phenomenon”). 44 Nonunion of a posterior talar process fracture can have a similar presentation.…”

“…75 PASTA provides safe, reliable, and minimally invasive access, superior visualization of the posterior talocalcaneal facet, easy screw fixation, less postoperative pain, and preservation of calcaneal/talar blood supply. 38,83…”