Functional Outcomes Following Ankle Fracture Fixation With or Without Ankle Arthroscopy
Ankle Fractures, Ankle Injuries, Arthroscopic Surgery
About this trial
This is an interventional treatment trial for Ankle Fractures focused on measuring functional outcomes of ankle fracture management, ankle scope, syndesmosis reduction, ankle ligaments evaluation
Eligibility Criteria
Inclusion Criteria: Patients ≥16 years of age who will be managed operatively for: rotational ankle fracture Danis-Weber classification B or C fibula fracture fracture dislocation ankle Fractures extending into the tibial plafond, Talus fractures (body or neck) in our institution Exclusion Criteria: Pediatric fractures, Polytrauma patients, Fractures managed with closed-contact casting and, patients with lost follow up during this study
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
those patients who will go for ORIF plus arthroscopy
patients who will go for ORIF without arthroscopy
we will start with a standard ankle arthroscopy. A leg holder and ankle joint distractor will be used. We will start with the anteromedial portal and introduce the 4-mm scope into the ankle joint. Next, under direct visualization, and taking care to preserve any branches of the superficial peroneal nerve, we will perform the anterolateral portal. We will carry out a standard diagnostic ankle arthroscopy to evaluate the ankle cartilage, wash intra-articular haematoma, identify, and remove any intra-articular fracture fragments and loose bodies, perform dynamic ligamentous stress examinations while directly visualizing the syndesmosis, the deltoid ligament, and the lateral collateral ligament. Following fracture fixation, arthroscopy will be also used as a second look to evaluate the quality of both articular and syndesmotic reduction, perform any needed arthroscopic intervention for deltoid ligament injury or management of chondral lesions (OCLs)
Posterior malleolus fractures will be addressed when it is present whatever its size. The fibula fractures will be fixated using either a posterolateral or direct lateral incision. Lag screws will be used when the fracture pattern allows, and all fractures will be also treated with a neutralization or antiglide plate depending on the pattern and approach. If a medial malleolus fracture is present, this will be addressed through a direct medial incision. These fractures will be either fixed with cannulated screws or tension band cerclage wiring or a plate and screw construct depending on the fracture pattern. Once all bony injuries will be stabilized, a Cotton test will be performed under live fluoroscopy to determine syndesmosis stability. If positive, the syndesmosis will be stabilized using fully threaded screws.