Do we Need Ankle Arthoscopy After Malleolar Fractures at the Time of Implant Removal?

OBJECTIVES: The purpose of this study was to evaluate the status of ankle joint arthroscopically, in patients with an appropriately treated ankle fracture. METHODS: Arthroscopic examination was performed at the time of implant removal after an average of 12.8 months (range 8 to 16 months) in a series of 40 consecutive patients. There were 24 women and 16 men with an average age of 55.4 years (range 17 to 67 years old). The Danis-Weber classification system was used for these fractures. All the patients were evaluated by the AOFAS Clinical Rating System before and after implant removal. RESULTS: In all the patients the fractures were healed without need of a second operation. Synovitis was present in all the patients and was located antero-laterally in 29 patients. Articular cartilage damage was noted in 19 patients, among whom 16 were treated by shaving and 3 were treated with the microfracture technique. In 13 patients we removed loose bodies. The lesions tended to be worse in patients over 60 years of age. The frequency and severity of the lesions also increased in type-B and type-C fractures. CONCLUSION: There is clear evidence that despite anatomic and appropriate reduction postoperative results of ankle fractures are not free of complications. Synovitis is a common finding after ankle fractures, and chondral lesions are commonly found associated especially with the more severe ankle fracture pattern. Our findings show that arthroscopy at the time of implant removal is useful in identifying and in treating intra-articular ankle lesions.