Arthroscopy-Assisted Syndesmotic Reduction in Ankle Fractures

Abstract

It is estimated that 10% of all ankle fractures and 20% of operatively treated ankle fractures are accompanied by a syndesmotic injury. The syndesmotic ligaments virtually prevent the lateral translation of the fibula. Syndesmotic instability represents a challenging problem. Complete disruption of the syndesmosis is generally evident on radiographs; however, studies have shown the inaccuracy of attempting to diagnose incomplete syndesmotic injuries using traditional radiographic measures. In this context, arthroscopic evaluation of distal tibiofibular joint stability is of considerable value in syndesmosis injury diagnosis. Despite the abundance of ankle fracture treatment literature, the need for distal tibiofibular syndesmotic fixation after ankle fracture remains controversial. Ankle arthroscopy provides a means of achieving complete intra-articular visualization and management of potential pathologic findings. The advantage of this technique is that it enables the assessment of different planes of instability and assists with anatomic syndesmosis reduction. The use of arthroscopic assistance in ankle fracture reduction is not routine for most surgeons, and there is insufficient evidence from which to derive specific indications. This technique has the advantages of assessing syndesmosis instability severity, checking fracture reduction quality, and enabling a thorough assessment of associated injuries.