Effect of Arthroscopic Evaluation of Acute Ankle Fractures on PROMIS Intermediate-Term Functional Outcomes

Fuchs, Daniel; Ho, Bryant S.; LaBelle, Mark W.; Kelikian, Armen S.

doi:10.1177/1071100715597657

Cited by 47 publications

(72 citation statements)

References 24 publications

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“…study demonstrated that orthopedic surgeons are leading users of PROMIS measures. Orthopedic surgery contributed 9 publications on topics including fractures21 , chronic foot and ankle disorders[22][23][24] , sacral tumors 1,2 , ACL injury25 , and orthopedic trauma26 . One fracture study evaluated a percutaneous approach to acetabular fractures27 and the other evaluated the use of routine arthroscopy in the management of ankle fractures 21 .…”

mentioning

confidence: 99%

Patient-Reported Outcomes Measurement Information System (PROMIS) Use in Surgical Care: A Scoping Study

Stukenborg

2017

Journal of the American College of Surgeons

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confidence: 99%

Patient-Reported Outcomes Measurement Information System (PROMIS) Use in Surgical Care: A Scoping Study

Stukenborg

2017

Journal of the American College of Surgeons

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“…In experienced hands, concomitant arthroscopy may only increase operative time by 15 to 20 minutes. 10 The techniques presented in this report are applicable to the sports, trauma, and foot/ankle surgeon.…”

Section: Discussionmentioning

confidence: 98%

“…6,7 Arthroscopic evaluation after ankle fracture shows a high prevalence of intra-articular pathology, although correlation with outcomes has been mixed. [8][9][10] There has yet to be an arthroscopic sign to characterize ankle instability intraoperatively. For the shoulder, the arthroscopic shoulder drive-through sign, originally reported by Pagnani and Warren, 11 is positive when the camera is easily passed between the glenoid and the humeral head into the anteroinferior joint space, which indicates laxity of the anterior capsule, usually after shoulder dislocation.…”

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confidence: 99%

Arthroscopically Assisted Open Reduction–Internal Fixation of Ankle Fractures: Significance of the Arthroscopic Ankle Drive-through Sign

Schairer

Nwachukwu

Dare

et al. 2016

Arthroscopy Techniques

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Standalone open reductioneinternal fixation (ORIF) of unstable ankle fractures is the current standard of care. Intraoperative stress radiographs are useful for assessing the extent of ligamentous disruption, but arthroscopic visualization has been shown to be more accurate. Concomitant arthroscopy at the time of ankle fracture ORIF is useful for accurately diagnosing and managing syndesmotic and deltoid ligament injuries. The arthroscopic ankle drive-through sign is characterized by the ability to pass a 2.9-mm shaver (Smith & Nephew, Andover, MA) easily through the medial ankle gutter during arthroscopy, which is not usually possible with both an intact deltoid ligament and syndesmosis. This arthroscopic maneuver indicates instability after ankle reduction and fixation and is predictive of the need for further stabilization. Furthermore, when this sign remains positive after fracture fixation, it may guide the surgeon to further evaluate the adequacy of fixation for the possible need for further fixation of the syndesmosis or deltoid. We present the case of an ankle fracture managed with arthroscopy-assisted ORIF and describe the clinical utility of the arthroscopic ankle drive-through sign.

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“…Previous investigations have revealed associated osteochondral lesions in the majority of patients undergoing concomitant ankle arthroscopy at the time of fracture management, ranging upwards of 79%. 3,[7][8][9][10][11] These investigations have typically included heterogenous fracture types in their analyses, and results have indicated that certain injury patterns have a stronger correlation with intraarticular injuries, such as Weber B and C fibula fractures as well as those with syndesmotic injuries. 3,7,[9][10][11] The prevalence of intra-articular pathology in the cohort of Liu et al is lower than that which has typically been reported.…”

Section: See Related Article On Page 1714mentioning

confidence: 99%

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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Effect of Arthroscopic Evaluation of Acute Ankle Fractures on PROMIS Intermediate-Term Functional Outcomes

Abstract: Level III, retrospective cohort study.

Cited by 47 publications

References 24 publications

Patient-Reported Outcomes Measurement Information System (PROMIS) Use in Surgical Care: A Scoping Study

Patient-Reported Outcomes Measurement Information System (PROMIS) Use in Surgical Care: A Scoping Study

Arthroscopically Assisted Open Reduction–Internal Fixation of Ankle Fractures: Significance of the Arthroscopic Ankle Drive-through Sign

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

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