Role of arthroscopy in treatment of acute ankle fractures

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Objective To explore the role of the arthroscopy in treatment of intra-articular lesions when an ankle joint has an acute fracture, and to evaluate advantages and disadvantages. Methods Seventy-eight patients with acute ankle fracture were treated with arthroscopy combined with open reduction and internal fixation from March 2016 to November 2017 in Sun Yat-sen Memorial Hospital.The cartilage injury, the damage of the deltoid ligament, the injury of the distal tibiofibular syndesmosis and the free fragments were recorded, and the correlation with the type of fracture was analyzed by chi-square test. Results In all the patients, six patients were suffered with type Weber A fracture, 45 were type Weber B fracture, 27 were type Weber C fracture. Cartilage injury was found in 51 patients (Weber A/B/C: 0/33/18), the distal tibiofibular syndesmosis injury was found in 39 patients(Weber A/B/C: 0/18/21), the deltoid ligament damage was in 27 patients(Weber A/B/C: 0/21/6), free fragments were found in seven patients(Weber A/B/C: 0/4/3 ). There was no significant difference between Weber B and Weber C in regard to the cartilage injury (χ2=0.363, P>0.05), but the degree of the cartilage injury was more sever in Weber B(Fisher’s exact test, P=0.007). There was no significant difference between Weber B and Weber C in regard to the distal tibiofibular syndesmosis(χ2=2.4 , P>0.05); in Weber C, the distal tibiofibular syndesmosis unstable was obvious correlated to posterior malleolus fracture(Fisher ’s exact test, P=0.02). There was significant difference between Weber B and Weber C in regard to the incidence of deltoid ligament injury(χ2=4.302, P<0.05); while the incidence of the medial malleolus fracture and the deltoid ligament injury was defined as medial instability of ankle, no significant difference was found between Weber B and Weber C (Fisher ’s exact test, P=0.07). Conclusion In treatment of acute ankle fracture, arthroscopy could find and deal with intra-articular lesions , also assist reduction and internal fixation, which is a useful auxiliary tool to improve the curative effect. Key words: Arthroscopy; Ankle fractures; Cartilage; Wounds and injuries; Ankle joint; Collateral ligaments