Arthroscopy-Assisted Reduction in the Management of Isolated Medial Malleolar Fracture

Liu, Chao; You, Jiaxing; Yang, Jie; Zhu, Hongxia; Yu, Hejun; Fan, Shunwu; Li, Hongye

doi:10.1016/j.arthro.2020.01.053

Cited by 11 publications

(23 citation statements)

References 38 publications

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“…Nonetheless, the quality of percutaneous xation and reduction is suboptimal, and delayed union and nonunion are likely to occur due to embedding of soft tissue in the fracture end 11 . Reduction and xation of medial malleolus fractures by using minimally invasive methods with the help of arthroscopy has also been assessed, but due to its steep learning curve and di culty in performing reduction, there are only a few reports on the treatment of medial malleolus fractures alone 12 .In addition, due to the relative lack of data for this technique compared with the amount of data on open reduction surgery, its e cacy has yet to be further con rmed. To minimize invasiveness under the premise of anatomical reduction, we modi ed the traditional anteromedial approach.…”

Section: Discussionmentioning

confidence: 99%

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Modified minimally invasive anteromedial approach with cannulated screw fixation for medial malleolus fracture: A novel technique

Qin

Zhang

2022

Preprint

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Background: In the treatment of medial malleolus fracture with traditional anteromeal ankle incision, the skin incision is larger and the incision-related complications are more. This study aims to explore the efficacy of this minimally invasive approach in the treatment of medial malleolus fracture.Methods: A retrospective analysis the patients with ankle fracture who were treated with modified minimally invasive anteromedial approach (MMITAA group) in our hospital between January 2019 and April 2020, and patients with ankle fracture treated with traditional anteromedial approach (TAA group) between January 2018 and December 2019. After regular follow-up, perioperative period, follow-up and imaging data of the two groups were compared to evaluate whether the therapeutic effect of the modified approach was better than that of the traditional approach.Results: The preoperative VAS score was 6.89 ± 1.74 in the MMIAA group and 7.17 ± 1.06 in the TAA group (P > 0.05). The VAS score in the MMIAA group was 4.97 ± 1.10 at 3 days after the surgery, which was significantly lower than the 6.20 ± 0.92 in the TAA group. The VAS score at 1 month after the surgery was still lower in the MMIAA group than in the TAA group.According to the results of postoperative ankle CT, the maximum postoperative step-off of the articular surface was 0.14 ± 0.12 mm in the MMIAA group and 0.18 ± 0.18 mm in the TAA group, but the difference was not statistically significant. The postoperative AOFAS score was 95.95 ± 6.81 points in the MMIAA group and 93.99 ± 8.74 points in the TAA group, which was slightly higher in the MMIAA group than in the TAA group, with no significant difference. Of the four subjective scores included in the AOFAS, the pain score of 38.15 ± 3.90 in the MMIAA group was significantly lower than the 36.51 ± 5.03 in the TAA group.All patients achieved fractrue healing.Conclusions: The modified minimally invasive anteromedial approach greatly shortened the lenth of incision, thereby reducing the incidence of incision-related complications, by smaller trauma achieve the same clinical effect.

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Section: Discussionmentioning

confidence: 99%

“…Many investigators have evaluated minimally invasive techniques to resolve the issue of medial malleolus incision complications. Although these techniques can reduce incision-related complications to a certain extent, several problems remain, such as limited visual eld, di culty of reduction, and limited indications [ 11] [12] .…”

Section: Introductionmentioning

confidence: 99%

Modified minimally invasive anteromedial approach with cannulated screw fixation for medial malleolus fracture: A novel technique

Qin

Zhang

2022

Preprint

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“…Liu, You, Yang, Zhu, Yu, Fan, and Li should be commended for their article, "Arthroscopy-Assisted Reduction in the Management of Isolated Medial Malleolar Fracture." 6 The authors prospectively evaluated 77 patients with isolated medial malleolar ankle fractures, of whom 34 underwent arthroscopic-assisted fracture reduction and percutaneous screw fixation and 43 were managed with fracture reduction and fixation using standard open techniques. The authors compared Olerud-Molander Ankle Score, pain scores, ankle range of motion, and radiographs between the 2 groups at multiple time points during the mean followup period of 5 years.…”

Section: See Related Article On Page 1714mentioning

confidence: 99%

“…The work of Liu et al is most relevant in this context. 6 The authors provided an excellent description of their arthroscopic technique for treating isolated medial malleolus fractures. Summarily, the authors ensured anatomic articular alignment arthroscopically while using a percutaneous reduction technique and screw fixation method.…”

Section: See Related Article On Page 1714mentioning

confidence: 99%

“…It must be noted that Liu et al did not randomize patients. 6 The choice of arthroscopy was made by the patient and surgeon, and it was disclosed that patients with insurance were more likely to choose concomitant arthroscopy. Thus, a selection bias exists and the potential for confounding must be considered by the reader.…”

Section: See Related Article On Page 1714mentioning

confidence: 99%

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Editorial Commentary: Optimizing Surgical Management of Ankle Fractures: Is Arthroscopy the Answer?

Sherman¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The surgical management of ankle fractures can be an unforgiving endeavor. Subtle malreductions in fracture fragments lead to significant deviations in joint reactive forces and, consequently, accelerated arthritis. The diagnosis of associated ligamentous pathology, such as deltoid and syndesmotic injuries, is often difficult and ideal surgical management is debated. Ankle fractures that are seemingly optimally managed using traditional surgical techniques may remain persistently painful and function poorlyda scenario that begs the question, was there more to the injury than met the eye (or radiographs)? Here, unrecognized concomitant intra-articular injuries and subtle surgical malreductions have been implicated. In my practice, concurrent ankle arthroscopy at the time of definitive acute ankle fracture reduction and fixation results in improved accuracy of reduction, evaluation and management of concomitant syndesmotic and ligamentous injuries, assessment and treatment of occult intra-articular injuries, options for less-invasive fixation techniques through arthroscopic reduction, and a means to provide prognostic patient information. I typically reserve its use for fracture patterns that have been more closely associated with intra-articular injuries: high-energy mechanism injuries, Weber B and C fibula fractures, and those with a high likelihood of syndesmotic disruption based on preoperative imaging. Despite these intuitive advantages, concurrent ankle arthroscopy for acute fracture fixation is not routinely performed by most orthopedic surgeons, and a relative dearth of literature regarding its use and clinical impact remains.

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Ankle fractures

Baumbach¹,

Böcker²,

Polzer³

2023

Arthroskopie

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Arthroscopy-Assisted Reduction in the Management of Isolated Medial Malleolar Fracture

Cited by 11 publications

References 38 publications

Modified minimally invasive anteromedial approach with cannulated screw fixation for medial malleolus fracture: A novel technique

Modified minimally invasive anteromedial approach with cannulated screw fixation for medial malleolus fracture: A novel technique

Editorial Commentary: Optimizing Surgical Management of Ankle Fractures: Is Arthroscopy the Answer?

Ankle fractures

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