PURPOSE: Malleolar fractures have been reported to be associated with a poor prognosis even when the anatomic reduction is complete. Soft tissue injuries such as damage to the cartilage and ligaments, soft tissue impingement, and the existence of free bodies within the intra-articular space account for this poor outcome. In treating fresh malleolar fractures, an arthroscope is used at our institution to confirm anatomic reduction on the articular surface and treat intra-articular injuries. This study evaluated the arthroscopic findings and surgical outcome for fresh malleolar fractures. TYPE OF STUDY: Prospective case study. METHODS: The subjects were 105 patients (105 joints) who had experienced malleolar fractures and had undergone surgical fixation between January 1996 and May 1999. Arthroscopy was used to confirm the fracture line, cartilaginous damage, presence of detached cartilaginous fragments in the articular space, ligament damage, and diastasis of the distal tibiofibular joint. The cartilaginous damage was treated using shaving, and the free cartilaginous fragments were excised. Diastasis of the distal tibiofibular joint was treated using distal tibiofibular joint fixation, using a screw. Fracture fixation was conducted after anatomic reduction had been confirmed using fluoroscopy and arthroscopy. RESULTS: Cartilaginous damage was noted in 21 patients, among whom 13 were treated by shaving and 8 underwent cartilaginous fragment removal. Fixation of the distal tibiofibular joint was conducted in 8 patients. From a postoperative radiographic evaluation, a good result in 100 cases and a fair outcome in 5 were confirmed. The clinical results were good in all, and no postoperative complications or pseudoarthrosis were noted. CONCLUSIONS: The use of an arthroscope during treatment of malleolar fractures enables diagnosis and treatment of the lesions within the ankle joint, producing a satisfactory surgical outcome. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series (no control group).
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