Ankle Arthroscopy Findings during Ankle Fracture Fixation and Mid-term Prognosis

Anatomic reduction of ankle fractures does not ensure a normal ankle function. This might be related to chondral damage during the fracture or other intra-articular pathology. Arthroscopy in the setting of acute operative management of ankle fractures provides a means to completely assess intra-articular pathology and sometimes even direct therapeutic intervention. To date there is no consensus in the literature regarding the indications for arthroscopy in the setting of ankle fractures. It is our practice to perform an arthroscopic assessment of all ankle fractures requiring surgical intervention. The current study retrospectively evaluated a consecutive series of twenty-two adult patients who underwent routine arthroscopy performed during open reduction and internal fixation of ankle fractures and its correlation with the clinical results at a follow-up of 2 years. The clinical results at 2 year follow-up results demonstrated an average AOFAS score of 82±8. Patients with grade 4 talar damage fared significantly worse (70±8) than both patients with grade 3 talar damage (83±7) and with normal talus structure during arthroscopy 87±9 (5.42, p<0.001).

In conclusion the findings of this limited series seem to indicate that final clinical results at 2 years follow-up correlate with the presence of chondral damage observed during arthroscopy. A randomized clinical trial should be performed in order to assess the possible advantages of ankle arthroscopy as compared with open reduction technique in improving treatment outcomes in ankle fracture fixation.