Arthroscopy added to ORIF for unstable ankle fractures did not affect function, pain at intermediate follow-up

LAS VEGAS — Arthroscopic evaluation of acute unstable ankle fractures performed in conjunction with open reduction and internal fixation did not appear to have an effect on the patient-reported function at mid-term follow-up, but investigators used arthroscopy to perform intra-articular treatments that would have been impossible to carry out otherwise, according to an investigator from Chicago.

During a presentation at the American Academy of Orthopaedic Surgeons Annual Meeting, here, Daniel J. Fuchs, MD, said arthroscopy added about 15 extra minutes of surgical time when patients were treated for unable ankle fractures, and this additional step was not associated with complications.

“Results of the study do not support the hypothesis that performing ankle arthroscopy at the time of [open reduction and internal fixation] ORIF improves patient outcomes at intermediate-term follow-up, however we can also conclude that arthroscopy in the setting of acute ankle fracture is a safe procedure which is not associated with a significant rate of complications and one that adds only limited time to the operation,” Fuchs said.

Fuchs and colleagues studied the concept of arthroscopy for patients with unstable ankle fractures with an intact medial malleolus by retrospectively reviewing cases managed by a single surgeon during a 10-year period, and performed a chart review. Ninety-eight patients met the study’s inclusion criteria and 51 patients were available to be surveyed at an average of 67 months postoperatively.

For the primary outcome instrument to compare functional outcomes between patients who underwent arthroscopy and the control patients did not undergo arthroscopy, the investigators used the Patient Reported Outcomes Measurement Information System (PROMIS), which validated in foot and ankle surgery, Fuchs said. The pain interference portion of PROMIS was also used to compare pain between the groups at 1-year minimum follow-up.

According to Fuchs, except for the fact there were more men in the arthroscopy group, the two groups were demographically similar.

The findings ultimately showed no significant differences in average PROMIS scores between the groups for physical function, which were 56.2 points and 54.2 points, respectively, for the arthroscopy and control groups. Pain interference for the arthroscopy and control groups based on the average PROMIS scores was 46.8 points and 47.0 points, respectively.

“There were significantly lower VAS pain scores in the arthroscopy group than the nonarthroscopy group, which was a secondary outcome measure,” Fuchs said.

The chart review showed patients in the arthroscopy group underwent such interventions as microfracture for full-thickness chondral lesions in three patients and loose body removal in nine patients, he said. – by Susan M. Rapp

Reference:

Fuchs DJ, et al. Paper #128. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.

Disclosure: Fuchs reports no relevant financial disclosures.