Arthroscopically-assisted Open Reduction and Internal Fixation of Ankle Fractures - Is it Superior to the Standard Approach?
Author(s):
Machado L. (Portugal)
,
Machado L. (Portugal)
Affiliations:
Barbosa L.
,
Barbosa L.
Affiliations:
Coelho Ana Marta
,
Coelho Ana Marta
Affiliations:
Figueiredo S.
,
Figueiredo S.
Affiliations:
Vide J.
,
Vide J.
Affiliations:
Mendes D.
,
Mendes D.
Affiliations:
Sousa M.
Sousa M.
Affiliations:
ESSKA Academy. MACHADO L. 05/09/18; 209221; P01-801 Topic: Arthroscopic Surgery
Mr. Luis MACHADO
Mr. Luis MACHADO
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Abstract
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Objectives: The objective of this study was to compare functional outcomes between Arthroscopically-Assisted Open Reduction and Internal Fixation (AAORIF) and Open Reduction and Internal Fixation (ORIF) for the treatment of ankle fractures. The hypothesis was that AAORIF yields better functional outcomes than ORIF

Methods: A retrospective monocentric cohort was performed. From 2012 to 2014, 116 ankle fractures were submitted to ORIF: 40 patients with arthroscopically assisted (Group A) and 76 without (Group B).
Group A patients were younger (45.1±14.9 vs 57.3±15.0; p<0.001) and more frequently male (p=0.005). Mean follow-up time was 48.84±6.38 months, similar between groups (A 47.48 and B 50.25). No significant difference was found regarding the Lauge-Hansen and Danis-Weber classifications. Outcome comparison relied on multivariate analysis of variance: arthroscopic aid was assumed as the independent variable and age, alternatively with the Foot and Ankle Outcome Score (FAOS) or the American Orthopaedic Foot & Ankle Society hindfoot (AOFAS) score, as dependent variables. Complications were assessed and compared in between groups. Statistical analysis was performed using IBM SPSS Statistics version 20.0.0., assuming statistical significance for a p-value <0.05. Student's t-test; Pearson's chi-squared test and Tukey's model for post-hoc analysis was used.

Results: Groups were similar in what regards the FAOS subgroups: pain (79.7±22.9 vs 84.6±17.8; p=0.753), symptoms (84.4±12.7 vs 89.5±13.3; p=0.762), activities of daily living (86.7±16.7 vs 89.9±14.2; p=0.845), sports and recreational activities (72.3±27.4 vs 69.6±28.8; p=0.551) and quality of life (70.2±30.5 vs 73.9±25.4; p=0.983). The same happened for the AOFAS score (83.2±16.6 vs 85.2±13.2; p=0.662).
Multivariate analysis of variance, on the other hand, revealed differences between groups for all FAOS subgroups and for the AOFAS score (p< 0.001, for all). Individually, neither age nor fracture pattern presented any correlation with any of the functional scores (p >0.05). Apart from a slight increase in complications during follow-up in Group A, it didn't reach statistical significance (p=0.187). Arthroscopy allowed us to observe that 75% of the patients had intra-articular pathology, specifically cartilage injuries in 40% in Group A. This data couldn't be compared with Group B.

Conclusions: This study did not find any difference with statistical significance between the two techniques. Despite the high prevalence of intra-articular lesions in group A there was no impact in the functional score which is in line with the poor treatment for cartilage injuries. The small differences in the FAOS scores are in line with the age and its demands. AAORIF is not better than ORIF for the treatment of ankle fractures.

Keywords:
Ankle Fractures; Arthroscopy; Patient reported outcomes
Objectives: The objective of this study was to compare functional outcomes between Arthroscopically-Assisted Open Reduction and Internal Fixation (AAORIF) and Open Reduction and Internal Fixation (ORIF) for the treatment of ankle fractures. The hypothesis was that AAORIF yields better functional outcomes than ORIF

Methods: A retrospective monocentric cohort was performed. From 2012 to 2014, 116 ankle fractures were submitted to ORIF: 40 patients with arthroscopically assisted (Group A) and 76 without (Group B).
Group A patients were younger (45.1±14.9 vs 57.3±15.0; p<0.001) and more frequently male (p=0.005). Mean follow-up time was 48.84±6.38 months, similar between groups (A 47.48 and B 50.25). No significant difference was found regarding the Lauge-Hansen and Danis-Weber classifications. Outcome comparison relied on multivariate analysis of variance: arthroscopic aid was assumed as the independent variable and age, alternatively with the Foot and Ankle Outcome Score (FAOS) or the American Orthopaedic Foot & Ankle Society hindfoot (AOFAS) score, as dependent variables. Complications were assessed and compared in between groups. Statistical analysis was performed using IBM SPSS Statistics version 20.0.0., assuming statistical significance for a p-value <0.05. Student's t-test; Pearson's chi-squared test and Tukey's model for post-hoc analysis was used.

Results: Groups were similar in what regards the FAOS subgroups: pain (79.7±22.9 vs 84.6±17.8; p=0.753), symptoms (84.4±12.7 vs 89.5±13.3; p=0.762), activities of daily living (86.7±16.7 vs 89.9±14.2; p=0.845), sports and recreational activities (72.3±27.4 vs 69.6±28.8; p=0.551) and quality of life (70.2±30.5 vs 73.9±25.4; p=0.983). The same happened for the AOFAS score (83.2±16.6 vs 85.2±13.2; p=0.662).
Multivariate analysis of variance, on the other hand, revealed differences between groups for all FAOS subgroups and for the AOFAS score (p< 0.001, for all). Individually, neither age nor fracture pattern presented any correlation with any of the functional scores (p >0.05). Apart from a slight increase in complications during follow-up in Group A, it didn't reach statistical significance (p=0.187). Arthroscopy allowed us to observe that 75% of the patients had intra-articular pathology, specifically cartilage injuries in 40% in Group A. This data couldn't be compared with Group B.

Conclusions: This study did not find any difference with statistical significance between the two techniques. Despite the high prevalence of intra-articular lesions in group A there was no impact in the functional score which is in line with the poor treatment for cartilage injuries. The small differences in the FAOS scores are in line with the age and its demands. AAORIF is not better than ORIF for the treatment of ankle fractures.

Keywords:
Ankle Fractures; Arthroscopy; Patient reported outcomes
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