Ankle Arthroscopy in Acute Ankle Fractures: Does It Make Sense?

Introduction: Displaced ankle fractures require surgery, bone healing generally occurs with satisfactory outcomes. In some cases, poor results are recorded related to posttraumatic arthritis or other complications. Occult lesions (osteochondral lesions, loose bodies, impingement syndrome) may be among the common causes of unsatisfactory outcomes. Most of them may be detected by a computed tomography (CT) scan at the emergency room; however, such evaluation is not routinely performed. The aim of this study was to evaluate the clinical results of patients undergoing open reduction and internal fixation (ORIF) and ankle arthroscopy for fractures associated with intra-articular lesions. Materials and Methods: Among 397 patients evaluated for displaced ankle fracture, we selected 13 patients who also presented with intraarticular alterations at the CT scan performed in the Emergency room. All subjects underwent ORIF and arthroscopy. Patients were evaluated by NRS and AO-FAS score for at least of 1-year of follow-up. Results: The mean follow-up was 2.7 years; all fractures fully healed. The mean age at the time of surgery was 33.5 years. A single complication was recorded (complex regional pain syndrome, healed 6 months after surgery). All subjects reported satisfaction with improvements of the scores and return to their daily life activities. Discussion: Occult injuries associated with ankle fractures should be suspected and ruled out by a CT scan at the emergency room. Probably many occult injuries are underestimated because CT scan is not commonly performed, explaining cases of bone healing but poor functional results. In case of confirmation, these alterations should be treated in association with ORIF; arthroscopy may represent a valid and minimally invasive procedure, with low rates of complications.