SLR - December 2014 - Tyler Silverman

Arthroscopic Assessment of Medial Malleolar Reduction

Reference: Swart EF, Vosseller JT. Arthroscopic Assessment of Medial Malleolar Reduction. Arch Orthop Trauma Surg. 2014 Sep;134(9): 1287-92.

Scientific Literature Review

Reviewed By: Tyler Silverman, DPM
Residency Program: The Cambridge Health Alliance

Podiatric Relevance: In many hospital systems, podiatrists are treating ankle fractures. Currently, the role of arthroscopy in the surgical reduction of ankle fractures is unclear. It has previously been used to evaluate for intra-articular pathology. This article provides new insight into the use of ankle arthroscopy to assess articular reduction.
Methods: This was a prospective study performed over one year. Inclusion criteria for the study were the presence of a medial malleolar ankle fracture that required open reduction and internal fixation (ORIF). Patients were excluded if they had previous ankle injury. Twelve consecutive patients were enrolled in the study. All patients were operated on by a single surgeon. The patients had ORIF of their medial malleolar fracture with arthroscopic evaluation.

Results: The main outcome of this study was comparing the reduction of the fracture as obtained by cortical cues. When using cortical cues, seven of the 12 patients had anatomic reduction. Of the five patients who did not have anatomic reduction, four had less than a 1 mm gap noted arthroscopically. Two of patients walked on their fracture for two weeks pre-operatively. One of these patients had a 2 mm gap noted arthroscopically. The other patient who ambulated on their fracture also had a more difficult reduction.

Conclusions: The authors concluded that cortical reduction of medial malleolar fractures often matched up with articular reduction. The greatest difficulties were encountered with patients who put weight on their splint pre-operatively. The authors concluded that this was because of impaction of the medial malleolus. The authors also briefly discussed that arthroscopy allowed them to evaluate and treat intra-articular pathology.

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