Abstract
Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the Lauge-Hansen fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, versus ORIF plus arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/- arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the Lauge-Hansen ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with an SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes.
Highlights
Ankle fractures occur in 0.1% of the population and are among the most common injuries treated by orthopaedic surgeons [1]
Ankle fractures are traditionally treated with open reduction and internal fixation (ORIF) alone, which have good to excellent outcomes [2]
This study aims to identify the associated presence of intra-articular and ligamentous injury in acute ankle fractures in patients undergoing ankle Open Reduction and Internal Fixation (ORIF) and arthroscopy in our institute, over a two-year period
Summary
Ankle fractures occur in 0.1% of the population and are among the most common injuries treated by orthopaedic surgeons [1]. Ankle fractures are traditionally treated with open reduction and internal fixation (ORIF) alone, which have good to excellent outcomes [2]. A minority of patients with ankle fractures develop persistent pain and impaired function following anatomic reduction [2]. 14% - 50% of patients develop post-traumatic arthritis following ankle fracture fixation [3]. These sequelae are thought to arise as a result of untreated ligamentous and/or chondral injuries [4]. There is emerging evidence to suggest that osteochondral lesions (OCL) sustained at the time of injury may be an independent prognostic indicator of functional outcome [5]. The concomitant presence of chondral injury is not always evident on plain film studies and is often underestimated on higher imaging modalities such as CT or MRI [6]
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