Comparison of Arthroscopic Reduction and Percutaneous Fixation Versus Open Reduction for Pediatric Intra-articular Epiphyseal Ankle Fractures.

Abstract

Background: This study aimed to compare the clinical outcomes of arthroscopic reduction and percutaneous fixation with those of open reduction and internal fixation for intra-articular epiphyseal ankle fractures.

Methods: We conducted a retrospective review of consecutive patients who underwent intra-articular epiphyseal ankle surgery between 2016 and 2021. A total of 88 patients were included and divided into 2 groups: the arthroscopic reduction group (AS group) and the conventional open reduction group (OR group). Fifteen patients were allocated to the AS group, and 30 were selected from the OR group using propensity score matching in a 1 : 2 ratio, considering demographics, fracture configuration, and follow-up period. The clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), while radiological evaluations were used to assess bone union and the congruence of the articular surface. We also analyzed complications such as infection, nonunion, angulation, leg length discrepancy, and posttraumatic osteoarthritis.

Results: There was a significant difference in follow-up periods between the groups in terms of demographics (p = 0.04); however, successful propensity score matching eliminated any differences in demographic and fracture configuration variables between the groups (all p > 0.05). The etiology of trauma was similar across other variables (p > 0.05). Postoperative FAOS ranged from good to excellent in both groups, with no significant differences between them (all p > 0.05). Both groups achieved bone union without nonunion, with no significant differences in bone union time or joint congruency (all p > 0.05). Although there were more complications in the OR group than in the AS group (3 vs. 0 cases), this difference was not statistically significant (p = 0.083).

Conclusions: Arthroscopic reduction and percutaneous fixation appear to be effective, minimally invasive options for the treatment of intra-articular epiphyseal ankle fractures, offering outcomes comparable to open reduction with a low rate of complications.