Arthroscopy-Assisted Surgery for Acute Ankle Fractures: A Systematic Review

Chen, Xing-Zuo; Chen, Ying; Liu, Chenggang; Yang, Huan; Xu, Xiaodong; Lin, Peng

doi:10.1016/j.arthro.2015.03.043

Cited by 48 publications

(35 citation statements)

References 41 publications

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“…Pires et al 9 reported a 10% complication rate of MIPPO for SER fractures, higher than that reported by Chiang et al 8 Also, the transfracture approach with a small incision can more easily enable reduction under direct vision, similar to the open method. 10 Arthroscopy has proven a reliable tool for evaluation of syndesmotic injuries, 11 reduction in medial malleolar fractures, 12 and evaluation of deep deltoid ligament injuries. 13 There is a possibility, therefore, that all of the procedures might influence the authors' outcomes of ARMIS for the patients with an SER ankle fracture.…”

Section: See Related Article On Page 2671mentioning

confidence: 99%

Editorial Commentary: Which Procedure Contributes to Best Outcomes After Arthroscopic Reduction and Minimally Invasive Surgery for Ankle Fractures?

Tohyama¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: See Related Article On Page 2671mentioning

confidence: 99%

Editorial Commentary: Which Procedure Contributes to Best Outcomes After Arthroscopic Reduction and Minimally Invasive Surgery for Ankle Fractures?

Tohyama¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…[12] It has been proven that chondral lesions would cause an unfavorable surgical outcome. [2,13] A recent published systematic review [14] showed that the incidence of chondral lesions in acute ankle fractures ranged from 20% to 88%. It was 72% (26/36) in our series.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and associated factors of intra-articular lesions in acute ankle fractures evaluated by arthroscopy and clinical outcomes with minimum 24-month follow-up

Chen

Zhu

et al. 2019

Chinese Medical Journal

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Background:Acute ankle fractures can lead to high rate of concomitant intra-articular lesions which may compromise clinical results. The purpose of this study was to evaluate the incidence of concomitant intra-articular lesions in acute ankle fractures with arthroscopy. We also sought to analyze the relationship between intra-articular lesions and the fracture type, as well as the severity of the fracture.Methods:It was a retrospective cohort study. From April 2014 to December 2015, we have chosen arthroscopy-assisted open reduction and internal fixation (AORIF) for the treatment of unstable acute ankle fractures. All concomitant intra-articular lesions were assessed and documented carefully and prospectively, such as ligament injuries, osteochondral lesions, and tibiofibular syndesmosis injuries. All fractures were classified according to the Lauge-Hansen classification system. The American Orthopedic Foot and Ankle Society's (AOFAS) ankle-hindfoot scale was used to assess post-operative function. Statistical comparisons between the intra-articular lesions, the fracture type, and the severity of the presenting fracture were performed using a Chi-squared analysis.Results:Data of 36 patients were analyzed in the study, including 23 supination-type fractures and 13 pronation-type fractures. The incidence of tibiofibular syndesmosis injuries, chondral lesions, and loose bodies were 92%, 72%, and 39%, respectively. Avulsion fractures of the anterior tibiofibular syndesmosis were more commonly found in supination-type fractures than pronation-type fracture (45% vs. 15%, χ2 = 5.78, P = 0.02), which would cause mechanical blocking in the anterior portion of the ankle. On the contrary, chondral lesions were more commonly found in the more severe fractures than mild fractures (86% vs. 53%, χ2 = 4.57, P = 0.03). A mean 41.7 months (range, 33.0–51.0 months) of follow-up was achieved. A mean AOFAS's ankle-hindfoot scale was 96.9, and 97.2% of the patients were satisfied with the procedure.Conclusions:Acute ankle fractures have a high incidence of concomitant intra-articular lesions. Avulsion fractures of the anterior tibiofibular syndesmosis are more commonly found in supination-type fractures. Chondral lesions are related to the severity of the fractures, but not with the classification of the fractures. AORIF can be one reliable solution in dealing with the associated injuries seen with acute ankle fractures.

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“…Chondral lesions occur in 20–89 % [ 3 , 15 ]. A recent review reported chondral lesions in 495 of 782 patients (63,3 %) with more than a half of these lesions localized on the talus [ 43 ]. For instance, Hintermann et al reported 79 % osteochondral lesion (OCL) in acute ankle fractures [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

The value of arthroscopy in the treatment of complex ankle fractures – a protocol of a randomised controlled trial

Braunstein

Baumbach

Regauer

et al. 2016

BMC Musculoskelet Disord

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BackgroundAn anatomical reconstruction of the ankle congruity is the important prerequisite in the operative treatment of acute ankle fractures. Despite anatomic restoration patients regularly suffer from residual symptoms after these fractures. There is growing evidence, that a poor outcome is related to the concomitant traumatic intra-articular pathology. By supplementary ankle arthroscopy anatomic reduction can be confirmed and associated intra-articular injuries can be treated. Nevertheless, the vast majority of complex ankle fractures are managed by open reduction and internal fixation (ORIF) only. Up to now, the effectiveness of arthroscopically assisted fracture treatment (AORIF) has not been conclusively determined. Therefore, a prospective randomised study is needed to sufficiently evaluate the effect of AORIF compared to ORIF in complex ankle fractures.Methods/designWe perform a randomised controlled trial at Munich University Clinic enrolling patients (18–65 years) with an acute ankle fracture (AO 44 A2, A3, B2, B3, C1 - C3 according to AO classification system). Patients meeting the inclusion criteria are randomised to either intervention group (AORIF, n = 37) or comparison group (ORIF, n = 37). Exclusion criteria are fractures classified as AO type 44 A1 or B1, pilon or plafond-variant injury or open fractures. Primary outcome is the AOFAS Score (American Orthopaedic Foot and Ankle Society). Secondary outcome parameter are JSSF Score (Japanese Society of Surgery of the Foot), Olerud and Molander Score, Karlsson Score, Tegner Activity Scale, SF-12, radiographic analysis, arthroscopic findings of intra-articular lesions, functional assessments, time to return to work/sports and complications. This study protocol is accordant to the SPIRIT 2013 recommendation. Statistical analysis will be performed using SPSS 22.0 (IBM).DiscussionThe subjective and functional outcome of complex ankle fractures is regularly unsatisfying. As these injuries are very common it is essential to improve the postoperative results. Potentially, arthroscopically assisted fracture treatment can significantly improve the outcome by addressing the intra-articular pathologies. Given the absolute lack of studies comparing AORIF to ORIF in complex ankle fractures, this randomised controlled trail is urgently needed to evaluate the effectiveness of additional arthroscopy.Trial registrationClinicalTrials.gov reference: NCT02449096 (Trial registration date: April 7th, 2015).

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Arthroscopy-Assisted Surgery for Acute Ankle Fractures: A Systematic Review

Cited by 48 publications

References 41 publications

Editorial Commentary: Which Procedure Contributes to Best Outcomes After Arthroscopic Reduction and Minimally Invasive Surgery for Ankle Fractures?

Editorial Commentary: Which Procedure Contributes to Best Outcomes After Arthroscopic Reduction and Minimally Invasive Surgery for Ankle Fractures?

Prevalence and associated factors of intra-articular lesions in acute ankle fractures evaluated by arthroscopy and clinical outcomes with minimum 24-month follow-up

The value of arthroscopy in the treatment of complex ankle fractures – a protocol of a randomised controlled trial

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