Saturday, April 17, 2010

Ankle fracture

Which ankle fractures are treated surgically? When do you treat them? The simple answer is that unstable ankle fractures are treated surgically. If both the medial and lateral sides of the ankle are fractured (called a bimalleolar ankle fracture) or if three sides are fractured (including the posterior malleolus, that is a trimalleolar ankle fracture), then surgical open reduction and internal fixation is recommendable. Fractures of the lateral malleolus alone, when displaced and in combination with a severe injury to the medial, or deltoid ligament, may also be unstable and benefit from surgical fixation. The timing for surgery is dependent on the skin and soft tissues, and is typically done around a week after the injury, to allow the swelling to minimize and thereby decrease risk for wound problems. The ankle fracture may also be treated within a few hours of the injury, before much swelling has developed.

Tuesday, April 6, 2010

Arthroscopy for ankle fractures?

When is ankle arthroscopy recommendable for ankle fractures? There are two randomized studies published on the use of arthroscopy in ankle fractures. One study demonstrated better results in patients who underwent arthroscopy at the time of open reduction internal fixation and the second study demonstrated equivalent results. Based on this data, I do not perform an ankle arthroscopy on all patients who have had an ankle fracture. With patient specific factors also considered, I tend to perform the arthroscopy on higher energy injuries, such as ankle subluxations or dislocations or syndesmosis injuries. At the time of arthroscopy, Ferkel reported a high rate of damage to the articular surfaces following ankle fractures, and my experience supports this fact. At the time of arthroscopy, loose bodies of cartilage alone or a combination of cartilage and bone can be treated, and the joint is looked at thoroughly to identify and treat any other associated injuries. This damage to the inside of the joint can be a cause of chronic pain if left untreated.