Diagnosis and treatment of combined intra-articular disorders in acute distal fibular fractures.
BACKGROUND
Some patients have residual ankle pain and disability after the treatment of an ankle fracture, despite the fracture site being well aligned. We identified intra-articular disorders in distal fibular fractures and sought to clarify the results of their operative treatment.


METHODS
This is a prospective, randomized study. Seventy-two patients with Weber type B distal fibular fractures were randomly treated with arthroscopy-assisted open reduction and internal fixation (AORIF) or with open reduction and internal fixation without arthroscopy (ORIF). In the AORIF group, the patients were followed for a mean duration of 3 years 4 months (range, 2 years 4 months-4 years 5 months). There were 27 male patients and 14 female patients. The mean age of the patients at the time of surgery was 36 years (range, 20-64 years). In the ORIF group, the patients were followed for a mean duration of 3 years 5 months (range, 2 years 7 months-4 years 5 months). There were 21 male patients and 10 female patients. The mean age of the patients at the time of surgery was 38 years (range, 20-58 years). We described intra-articular disorders in the AORIF group using ankle arthroscopy and compared their operative results with those of the ORIF group.


RESULTS
Including duplication, the arthroscopic findings showed 30 cases with osteochondral lesions of the talar dome (73.2%) and 33 cases with tibiofibular syndesmosis disruptions (80.5%). Six cases (14.6%) had no combined disorders. The mean AOFAS score was 91.0 +/- 3.5 (range, 85-100) in the AORIF group, in contrast to 87.6 +/- 5.5 (range, 77-97) in the ORIF group (p = 0.0106).


CONCLUSIONS
In the treatment of distal fibular fractures, precisely diagnosing and treating the combined intra-articular disorders is important for gaining satisfactory clinical results.
Takao
Masato
M
Department of Orthopaedic Surgery, Shimane University School of Medicine, Enya, Izumo, Shimane, Japan.
Uchio
Yuji
Y
Naito
Kohei
K
Fukazawa
Ikuo
I
Kakimaru
Tomoyuki
T
Ochi
Mitsuo
M
D000328:Adult; D016512:Ankle Injuries / Q000150:complications / Q000601:surgery*; D000843:Ankle Joint; D001182:Arthroscopy; D005260:Female; D005360:Fibula / Q000293:injuries*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies