Arthroscopic assisted fixation of posterior malleolus fractures: Technical pearls and clinical outcomes.

Background: Posterior malleolus (PM) fractures compromise overall ankle stability, lending to poorer long-term prognosis without adequate fixation. There remains inconsistency in the preferred surgical approach to fixation of the posterior malleolus, however arthroscopic approaches can reduce trauma to the soft tissue envelope and may improve clinical and radiographic outcomes. This study reviews the technical considerations of arthroscopic-assisted reduction and fixation of PM fractures and the associated clinical outcomes.

Methods: A systematic review of Pubmed, EMBASE, and UNE Library Services databases included studies evaluating arthroscopic assisted treatment of ankle fractures with associated posterior malleolus fragment.

Results: Seven studies evaluating 101 patients who underwent fixation of ankle fractures with posterior malleolus involvement met inclusion criteria. Twenty-seven patients underwent open reduction internal fixation (ORIF) alone and 74 patients underwent various arthroscopic-assisted reductions of PM fractures. The studies reported no significant difference in VAS and AOFAS scores in ORIF vs arthroscopic approach, and favorable VAS, AOFAS, OMAS, and FADI scores in arthroscopically treated patients. Acceptable radiographic differences were reported in each case. Complication rates in arthroscopic groups were minimal (mean 12 %). Reported benefits of arthroscopic assistance include improved visualization, debridement, and manipulation of the posterior malleolar fragment.

Conclusion: Fixation of ankle fractures involving the posterior malleolus consistently report favorable clinical outcomes in patients treated with arthroscopy, with many patients achieving desirable AOFAS, OMAS, FADI, and VAS scores with a very low complication rate.

Level of evidence: Level I, systematic review.