Arthroscopy assisted fixation of posterior malleolar fractures: case series for novel approach

Abstract

Background: Posterior malleolar fractures are not uncommon ankle injuries. Despite their biomechanical significance for syndesmotic stability and stress distribution, there is no consensus about which fractures to treat surgically. The purpose of this study was to evaluate arthroscopic guided fixation of posterior malleolar fractures. This technique is hypothesized to provide visualized optimal reduction in a minimally invasive manner. Methods: Twelve consecutive ankle injuries with posterior malleolar fracture were treated and enrolled in this prospective study. The standard procedure included posterior ankle arthroscopic guided reduction and cannulated screw fixation of the posterior malleolus. Patients were evaluated using the Foot and Ankle Outcome Score (FAOS) and Ankle-Hindfoot scale. A composite questionnaire, including the EQ-5D and visual analog scales (VAS) for pain and satisfaction was accomplished. Results: Postoperatively, all radiographs showed good reduction of the posterior malleolus and an even joint, with a mean tibiofibular clear space of 4.2 mm. All patients had returned to their preinjury activity levels at their final follow-up. The mean FAOS score for patients included in the study was 92.46, and the mean Ankle-Hindfoot score was 92.0. Adequate range of motion was achieved in relation to the contralateral ankle, with insignificant comparative chi-square statistic at a P-value of 0.99, and overall satisfaction scale of 9.42. Conclusions: Arthroscopic guided fixation of the posterior malleolar fracture is an effective treatment modality that achieves direct reduction of the fracture, faster rehabilitation, and has a lower risk of neurovascular complications.