Role of Ankle Arthroscopy in Management of Acute Ankle Fracture.
To report the operative findings of ankle arthroscopy during open reduction and internal fixation of acute ankle fractures.



This was a retrospective review of 254 consecutive patients with acute ankle fractures who were treated with open reduction and internal fixation of the fractures, and ankle arthroscopy was performed at the same time. The accuracy of fracture reduction, the presence of syndesmosis disruption and its reduction, and the presence of ligamentous injuries and osteochondral lesions were documented. Second-look ankle arthroscopy was performed during syndesmosis screw removal 6 weeks after the key operation.



There were 6 patients with Weber A, 177 patients with Weber B, 51 patients with Weber C, and 20 patients with isolated medial malleolar fractures. Syndesmosis disruption was present in 0% of patients with Weber A fracture, 52% of patients with Weber B fracture, 92% of patients with Weber C fracture, and 20% of the patients with isolated medial malleolar fracture. Three patients with Weber B and one patient with Weber C fracture have occult syndesmosis instability after screw removal. Osteochondral lesion was present in no patient with Weber A fracture, 26% of the Weber B cases, 24% of the Weber C cases, and 20% of isolated medial malleolar fracture cases. The association between the presence of deep deltoid ligament tear and syndesmosis disruption (warranting syndesmosis screw fixation) in Weber B cases was statistically significant but not in Weber C cases. There was no statistically significant association between the presence of posterior malleolar fracture and syndesmosis instability that warrant screw fixation.



Ankle arthroscopy is a useful adjuvant tool to understand the severity and complexity of acute ankle fracture. Direct arthroscopic visualization ensures detection and evaluation of intra-articular fractures, syndesmosis disruption, and associated osteochondral lesions and ligamentous injuries.



Level IV, case series.
Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China.
Kwok Bill
KB
Chan
Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China. Electronic address: luithderek@yahoo.co.uk.
Tun Hing
TH
Lui
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery; D001182:Arthroscopy / Q000379:methods; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction; D012189:Retrospective Studies; D024162:Second-Look Surgery; D055815:Young Adult