AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Do We Scope All Ankle Fractures

Do We Scope All Ankle Fractures_-Richard Ferkel, M.D

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This document discusses the role, indications, contraindications, techniques, and findings of arthroscopy in managing acute ankle fractures. Arthroscopy aids in the reduction and internal fixation of fractures, allowing direct visualization and treatment of intraarticular pathology such as ligament injuries, osteochondral lesions, and loose bodies prior to open reduction and internal fixation (ORIF).<br /><br />Indications for arthroscopy include acute ankle fractures with minimal to mild displacement and swelling, no neurovascular injury, and fractures reducible by manipulation. Contraindications include moderate to severe swelling, neurovascular injury, open fractures, and displaced fractures. The technique involves patient paralysis, gentle joint distraction, establishment of anteromedial, anterolateral, and posterolateral portals, thorough joint washout, careful fracture evaluation, and fixation often using cannulated screws guided by fluoroscopy.<br /><br />Specific fracture types such as Tillaux fractures—avulsions of the anterior tibial epiphysis common in adolescents—and triplane fractures in young patients are highlighted. Studies referenced show a high incidence (up to 79%) of cartilage lesions associated with ankle fractures, correlated with post-traumatic arthritis development. Arthroscopy is superior to stress x-rays in diagnosing syndesmosis injuries, guiding treatment with screws or tightropes.<br /><br />Intraarticular pathological findings commonly observed include chondromalacia, free fracture fragments, ligament tears, and traumatic articular surface lesions. The document underscores that arthroscopy reveals unstable articular surfaces and associated pathologies that may affect outcomes. It advocates for thorough joint examination, gentle soft tissue handling, complete joint washout, fluoroscopy-assisted fixation, and adoption of modern techniques to improve treatment results.<br /><br />In summary, ankle arthroscopy is valuable in evaluating and managing acute fractures, detecting intraarticular injuries, guiding fixation, and potentially reducing the risk of post-traumatic arthritis in selected patients with acute ankle fractures.

Keywords

ankle arthroscopy

acute ankle fractures

intraarticular pathology

ligament injuries

osteochondral lesions

Tillaux fractures

triplane fractures

post-traumatic arthritis

syndesmosis injuries

fluoroscopy-guided fixation