Arthroscopically Assisted Treatment of Complex Ankle Fractures: Intra-articular Findings and 1-Year Follow-Up

Braunstein, Mareen; Baumbach, Sebastian Felix; Urresti-Gundlach, Marcel; Borgmann, Lars; Böcker, Wolfgang; Polzer, Hans

doi:10.1053/j.jfas.2019.05.003

Cited by 20 publications

(22 citation statements)

References 41 publications

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“…The utility of arthroscopy in the treatment of ankle fractures continues to be a point of discussion in the orthopedic literature. 1,6,8,12 In this article, we demonstrate the utility of arthroscopy to diagnose deep deltoid ruptures in a minimally invasive fashion through the visualization of the posterior tibialis tendon, an otherwise extra-articular structure. In this study, the visualization of this anatomic structure was used as the standard means of diagnosis to verify the radiographic findings.…”

Section: Discussionmentioning

confidence: 99%

“…Lateral radiographs were examined to make sure that the plantarflexion in the injury films was not excessive (<20 degrees). 6,16…”

Section: Methodsmentioning

confidence: 99%

“…Arthroscopic assessment of ankle fractures has gained attention in the past few years, with the purported benefits of helping diagnose intra-articular pathology such as osteochondral lesions, removal of loose bodies, helping diagnose syndesmotic injury, assisting with fracture reduction, lavage of cytotoxic cytokines, and assessment of deep deltoid injuries. 2,5,6,7 At our institution, our protocol for LSER ankle fractures is to use ankle arthroscopy to evaluate the deep deltoid ligament (DDL) prior to fibular fracture reduction and fixation. During ankle arthroscopy, visualization of the posterior tibialis tendon, an extra-articular tendon, as it passes around the medial malleolus, indicates that the deep ligament is not intact.…”

Section: Introductionmentioning

confidence: 99%

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Correlating Arthroscopic and Radiographic Findings of Deep Deltoid Ligament Injuries in Rotational Ankle Fractures

et al. 2020

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Background: The deep deltoid ligament (DDL) is a key stabilizer to the medial ankle and ankle mortise and can be disrupted in ligamentous supination external rotation type IV (LSER4) ankle fractures. The purpose of this study was to define the medial clear space (MCS) measurement on injury mortise radiographs that corresponds with complete DDL injury. Methods: A retrospective record review at a level 1 hospital was performed identifying patients with LSER4 ankle fractures who underwent arthroscopy and open reduction internal fixation. Chart reviews provided arthroscopic images and operative reports. Complete DDL injury was defined as arthroscopic visualization of the posterior tibial tendon (PTT). Inability to completely visualize the PTT was defined as a partial DDL injury. MCS was measured on injury mortise radiographs. Eighteen subjects met inclusion criteria. Results: Twelve subjects had complete and 6 subjects had partial DDL injury based on arthroscopic findings. Patients with complete DDL injury and those with partial DDL injury had injury radiograph MCS ranging from 5.5 to 29.9 mm and 4.0 to 5.0 mm, respectively. All patients with MCS ≥5.5 mm on injury radiographs had complete DDL injury and all patients with MCS ≤5.0 mm on injury radiographs had partial DDL injury. Conclusion: Complete DDL injury was found on injury ankle mortise radiographs as MCS widening of ≥5.5 mm, which correlated with arthroscopic visualization of the PTT. Using this cutoff, surgeons can surmise the presence of a complete deltoid ligament injury, allowing for improved preoperative planning. Level of Evidence: Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%

“…Lateral radiographs were examined to make sure that the plantarflexion in the injury films was not excessive (<20 degrees). 6,16…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Correlating Arthroscopic and Radiographic Findings of Deep Deltoid Ligament Injuries in Rotational Ankle Fractures

et al. 2020

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“…For the prospective AORIF cohort, the detailed selection process, intraoperative findings, and PROMs for the AORIF cohort after 1 year have been published previously. 5 In brief, all patients presenting to our department between May 2013 and December 2014 older than 17 years of age, with an acute bimalleolar equivalent, bimalleolar, or trimalleolar ankle fracture, which we considered complex fractures, were treated by AORIF. The inclusion and exclusion criteria are depicted in Table 1.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Still, it has been shown that the complexity of an ankle fracture has a significant influence on the outcome 15,17,26,28 and that the number and severity of chondral injuries increase with the complexity of the fracture. 1,5,14,16,18,27 Therefore, the focus on more simple fractures in these studies limits the assessment of the impact that arthroscopy could have. It is possible that the positive impact of AORIF in the treatment of ankle fractures would increase with the complexity of the fracture.…”

Section: Introductionmentioning

confidence: 99%

Propensity Score–Matched Analysis of Arthroscopically Assisted Ankle Facture Treatment Versus Conventional Treatment

et al. 2020

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Background: The aim of this study was to assess the prospective, longitudinal outcome after arthroscopically assisted open reduction and internal fixation (AORIF) and to compare the results with open reduction and internal fixation (ORIF) in complex ankle fractures. Methods: Acute, closed, bimalleolar equivalent, bimalleolar, or trimalleolar ankle fractures were included. The AORIF cohort was enrolled prospectively. The ORIF group was identified from a retrospective database. The same inclusion and exclusion criteria were applied. The only difference was the additional arthroscopy in the AORIF cohort. The patient-reported outcome measurement (PROM) following AORIF was assessed at 1 and 4 years of follow-up using the Olerud and Molander Ankle Score (OMAS) and Tegner activity scale (TAS). The AORIF cohort was propensity score matched (nearest-neighbor matching) to the ORIF database. The OMAS and Foot and Ankle Ability Measure (FAAM) were compared between the resulting groups. Nonparametric statistics were applied; values are presented as median (interquartile range). Twenty-six AORIF patients had a prospective 4-year follow-up. Results: No significant differences (1 year vs 4 years) were identified for the OMAS (90 [10] vs 90 [11]) and TAS (4 [2] vs 5 [2]). The severity of the cartilage lesions (International Cartilage Repair Society [ICRS] grade <4 vs ICRS of 4) had no significant influence on the PROMs. Twenty-five patients per cohort (AORIF vs ORIF) were matched. The OMAS (90 [13] vs 75 [40]; P = .008) and FAAM Activities of Daily Living (ADL; 96 [11] vs 88 [30]; P = .034) revealed significantly better outcomes for AORIF. More patients in the AORIF cohort returned to sport (96% vs 77%; P = .035), with a higher FAAM Sports score (88 [37] vs 56 [47]; P = .008). Conclusion: AORIF for complex ankle fractures led to consistently good to excellent results. The propensity score–matched analysis revealed a significantly better outcome 4 years after surgery for AORIF compared with ORIF. Level of Evidence: Level III, retrospective comparative study.

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Nachbehandlung von operativ versorgten Sprunggelenkfrakturen

et al. 2021

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Arthroscopically Assisted Treatment of Complex Ankle Fractures: Intra-articular Findings and 1-Year Follow-Up

Cited by 20 publications

References 41 publications

Correlating Arthroscopic and Radiographic Findings of Deep Deltoid Ligament Injuries in Rotational Ankle Fractures

Correlating Arthroscopic and Radiographic Findings of Deep Deltoid Ligament Injuries in Rotational Ankle Fractures

Propensity Score–Matched Analysis of Arthroscopically Assisted Ankle Facture Treatment Versus Conventional Treatment

Nachbehandlung von operativ versorgten Sprunggelenkfrakturen

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