Arthroscopic Reduction and Minimally Invasive Surgery in Supination–External Rotation Ankle Fractures: A Comparative Study With Open Reduction

Abstract

To describe an algorithm for arthroscopic reduction and minimally invasive surgery (ARMIS) and compare the surgical outcomes with standard open reduction-internal fixation (ORIF) for the treatment of supination-external rotation (SER) ankle fractures. The inclusion criteria for this study were patients aged 16years or older, the presence of a unilateral SER fracture, and injuries less than 2weeks old. We retrospectively identified patients with SER fractures who underwent ORIF from January 2008 to December 2011 or ARMIS from January 2012 to December 2015. Data collected in December 2013 for the ORIF group and in December 2017 for the ARMIS group were compared. The algorithm for ARMIS was minimally invasive plating for lateral malleolar fractures first, followed by ankle arthroscopy for detection of syndesmotic injuries and then arthroscopic reduction of medial malleolar fractures or mini-open repair of the deltoid ligament. The talocrural angle, fibular length, tibiomedial malleolar angle, medial clear space, and tibiofibular clear space were measured radiographically. Functional evaluations included the visual analog scale pain score, American Orthopaedic Foot & Ankle Society ankle-hindfoot scales, and range of motion of bilateral ankles. Complications and reoperations were recorded for comparison. A total of 105 patients with SER fractures, 65 in the ARMIS group and 40 in the ORIF group, were included. Significantly lower incidences of complications (7.7% vs 27.5%, P= .006) and reoperations (1.5% vs 12.5%, P= .029) were found in the ARMIS group than in the ORIF group. More syndesmotic injuries were detected in the ARMIS group than in the ORIS group (80% vs 57.5%, P= .021). The visual analog scale pain score was significantly lower on day 3 postoperatively in the ARMIS group than in the ORIS group (1.96 ± 1.18 vs 2.83 ± 1.07, P= .027). The postoperative stay was shorter in the ARMIS group than in the ORIF group (3.66 ± 1.39days vs 4.46 ± 2.23days, P= .024). The operative time was longer in the ARMIS group than in the ORIS group (105.22 ± 27.13minutes vs 93.59 ± 22.79minutes, P= .038). A longer fluoroscopic time (0.43 ± 0.25minutes vs 0.17 ± 0.07minutes, P < .001) and a higher dose of irradiation (1,216.46 ± 603.99μGy vs 389.38 ± 217.89μGy, P < .001) were observed in the ARMIS group. No significant differences in radiographic measurements were found between the operative and nonoperative ankles in both groups. Our algorithm and the ARMIS techniques may be a safe, reliable, and effective option in the treatment of SER fractures. ARMIS achieves promising surgical outcomes with less early postoperative pain, a shorter postoperative stay, and lower incidences of complications and reoperations compared with ORIF. However, the operative time is longer and the irradiation dose is higher with the ARMIS techniques. Level III, retrospective comparative study.