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Arthroscopy-assisted reduction versus open reduction in the fixation of medial malleolar fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Purpose of this case–control study was to evaluate the feasibility and advantages of arthroscopically assisted reduction and internal fixation of isolated medial malleolar fractures and compare the outcomes with conventional open reduction and internal fixation.

Methods

Forty-seven patients with medial malleolar fractures were grouped into two: arthroscopy-assisted group, and conventional open reduction and internal fixation group. Arthroscopic treatment group consisted of 21 patients. The mean age was 34 years (range: 22–49 years). Conventional open reduction and internal fixation group included 26 patients. The mean age was 42 years (range: 22–58 years). According to Herscovici system, 6 fractures in the arthroscopy group were classified as type-B, 13 fractures as type-C, and 2 fractures were classified as type-D. In both groups, fractures were classified according to Herscovici system. Radiological and clinical outcomes were evaluated according to van Dijk classification and Olerud–Molander scoring system, respectively.

Results

The mean follow-up period was 26 months (18–52 months) for arthroscopically assisted group and 38 months (24–58 months) for the conventional group. According to van Dijk classification, there was only one patient with Grade 1 osteoarthritic changes in arthroscopically assisted group compared with the conventional group where two patients had Grade 2 and one patient had Grade 1 osteoarthritic changes. Median Olerud Scores were 92.3 (75–100) and 86.3 (70–100) for the arthroscopically assisted group and for the conventional group, respectively. The difference was statistically significant (p = 0.015).

Conclusions

With the use of arthroscopically assisted techniques in fixation of isolated medial malleolar fractures, surgeon can evaluate intra-articular surface and reduction that may be of value in the improvement in clinical outcomes over conventional surgical treatment.

Level of evidence

Case–control study, Level III.

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References

  1. Daly PJ, Fitzgerland RH Jr, Melton LJ, Ilstrup DM (1987) Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand 58:537–544

    Article  Google Scholar 

  2. Kralinger F, Lutz M, Wambacher M, Smekal V, Golser K (2003) Arthroscopically assisted reconstruction and percutaneous screw fixation of a pilon tibial fracture. Arthroscopy 19(5):E45

    Article  PubMed  Google Scholar 

  3. Porter DA, May BD, Berney T (2008) Functional outcome after operative treatment for ankle fractures in young athletes: a retrospective case series. Foot Ankle Int 29(9):887–894

    Article  PubMed  Google Scholar 

  4. Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 58A:356–357

    Google Scholar 

  5. Specchiulli F, Mangialardi R (2004) The surgical treatment of malleolar fractures: long-term results. Chir Organi Mov 89(4):313–318

    PubMed  CAS  Google Scholar 

  6. Ono A, Nishikawa S, Nagao A, Irie T, Sasaki M, Kouno T (2004) Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes. Arthroscopy 20(6):627–631

    Article  PubMed  Google Scholar 

  7. van Dijk CN, Verhagen RA, Tol JL (1997) Arthroscopy for problems after ankle fracture. J Bone Joint Surg 79:280–284

    Article  Google Scholar 

  8. Hintermann B, Regazzoni P, Lampert C, Stutz G, Gächter A (2000) Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br 82(3):345–351

    Article  PubMed  CAS  Google Scholar 

  9. Loren GJ, Ferkel RD (2002) Arthroscopic assessment of occult intra-articular injury in the acute ankle fractures. Arthroscopy 18(4):412–421

    Article  PubMed  Google Scholar 

  10. Panagopoulos A, van Niekerk L (2007) Arthroscopic assisted reduction and fixation of a juvenile Tillaux fracture. Knee Surg Sports Traumatol Arthrosc 15(4):415–417

    Article  PubMed  CAS  Google Scholar 

  11. Carr James B (2003) Malleolar fractures and soft tissue injuries of the ankle. In: Browner BD et al (eds) Skeletal Trauma: basic science, management and reconstruction, 3rd edn. Saunders, Philadelphia, pp 2307–2374

    Google Scholar 

  12. Singh R, Ajuied A, Davies M (2006) Results of early surgical intervention after suboptimal ankle fracture fixation. Injury. 37(9):899–904

    Article  PubMed  CAS  Google Scholar 

  13. SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS (2009) Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am 91(5):1042–1049

    Article  PubMed  Google Scholar 

  14. Herscovici D Jr, Scaduto JM, Infante A (2007) Conservative treatment of isolated fractures of the medial malleolus. J Bone Joint Surg Br 89(1):89–93

    Article  PubMed  Google Scholar 

  15. Olerud C, Molander H (1984) A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg 103(3):190–194

    Article  PubMed  CAS  Google Scholar 

  16. Leontaritis N, Hinojosa L, Panchbhavi VK (2009) Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am 91:333–339

    Article  PubMed  Google Scholar 

  17. Takao M, Uchio Y, Naito K, Fukazawa I, Kakimaru T, Ochi M (2004) Diagnosis and treatment of combined intra-articular disorders in acute distal fibular fractures. J Trauma 57(6):1303–1307

    Article  PubMed  Google Scholar 

  18. Lindjsö U (1985) Operative treatment of ankle fracture-dislocations. A follow-up study of 306/312 consecutive cases. Clin Orthop Relat Res 199:28–38

    Google Scholar 

  19. Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, Llinias A (2002) Articular fractures:does an anatomic reduction really change the result? J Bone Joint Surg Am 84-A(7):1259–1271

    PubMed  CAS  Google Scholar 

  20. Stufkens AS, Knupp M, Horisberger M, Lampert C, Hintermann B (2010) Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures. J Bone Joint Surg Am 92:279–286

    Article  PubMed  Google Scholar 

  21. Imade S, Takao M, Miyamoto W, Nishi H, Uchio Y (2009) Leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. Arthroscopy 25(2):215–218

    Article  PubMed  Google Scholar 

  22. Thordarson DB, Bains R, Shepherd LE (2001) The role of ankle arthroscopy on the surgical management of ankle fractures. Foot Ankle Int 22(2):123–125

    PubMed  CAS  Google Scholar 

  23. Ferkel RD, Scranton PE Jr (1993) Arthroscopy of the ankle and foot. J Bone Joint Surg Am 75(8):1233–1242

    PubMed  CAS  Google Scholar 

  24. Aktas S, Kocaoglu B, Gereli A, Nalbantodlu U, Güven O (2008) Incidence of chondral lesions of talar dome in ankle fracture types. Foot Ankle Int 29(3):287–292

    Article  PubMed  Google Scholar 

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Acknowledgments

Authors wish to thank Sibel Kıran, MD, for the statistical analysis.

Conflict of interest

All authors state that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Faculty of Medicine, Zonguldak Karaelmas University, Esenköy, Kozlu, Zonguldak, Turkey

    Egemen Turhan

  2. Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Mahmut Nedim Doral & Ahmet Ozgur Atay

  3. Department of Orthopaedics and Traumatology, Bayindir Hospital, Ankara, Turkey

    Murat Demirel

  4. Department of Orthopaedics and Traumatology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey

    Murat Bozkurt

  5. Department of Orthopaedics and Traumatology, Faculty of Medicine, Selçuk University, Konya, Turkey

    Onur Bilge

  6. Department of Orthopaedics and Traumatology, Faculty of Medicine, Çukurova University, Adana, Turkey

    Gazi Huri

  7. Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Kivanc Atesok

  8. Department of Sports Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Defne Kaya

Authors
  1. Egemen Turhan
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  2. Mahmut Nedim Doral
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  3. Murat Demirel
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  4. Ahmet Ozgur Atay
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  5. Murat Bozkurt
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  6. Onur Bilge
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  7. Gazi Huri
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  8. Kivanc Atesok
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  9. Defne Kaya
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Correspondence to Mahmut Nedim Doral.

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Turhan, E., Doral, M.N., Demirel, M. et al. Arthroscopy-assisted reduction versus open reduction in the fixation of medial malleolar fractures. Eur J Orthop Surg Traumatol 23, 953–959 (2013). https://doi.org/10.1007/s00590-012-1100-2

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  • DOI: https://doi.org/10.1007/s00590-012-1100-2

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