Ankle arthroscopy combined with hardware removal for chronic pain after ankle fracture
ESSKA Academy. NIKOLOPOULOS D. 11/08/19; 284345; epAFAS-02
Dr. DIMITRIOS NIKOLOPOULOS
Dr. DIMITRIOS NIKOLOPOULOS
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Ankle arthroscopy combined with hardware removal for chronic pain after ankle fracture

ePoster - epAFAS-02

Topic: Arthroscopy

Nikolopoulos D.1, Safos G.1, Moustakas K.1, Anastasiou I.1, Safos P.2, Siderakis A.2, Fragkomichalos E.3
1Central Clinic of Athens, Orthopaedic, Athens, Greece, 2Ikaria General Hospital, Orthopaedic, Ikaria, Greece, 3General Hospital of Chios, Orthopaedic, Chios, Greece

Introduction: Ankle fractures (unstable) are commonly treated by orthopaedic surgeons with open reduction and internal fixation (ORIF). After the fracture healing, many patients complaint about localized chronic ankle pain caused by hardware irritation, osteophytes, intraarticular damage, or caused by synovitis or arthrofibrosis; that's why request to remove hardware, expecting pain relief. Such ongoing pain may result from intra-articular injury sustained at the time of fracture or anterolateral soft-tissue impingement or synovitis that developed after the fracture.
Objectives: The purpose of this study is to evaluate the effectiveness of arthroscopy combined with hardware removal for chronic pain after satisfactory healing of an ankle fracture.
Aim: It is hypothesized that combining hardware removal with arthroscopy for the intra-articular pathology would improve residual complaints more so than hardware removal alone.
Methods: The last decade, the outcomes of the 144 patients (78 male vs 66 female) of mean age 33,2 years old (range 16 to 55) with chronic pain after healed ankle fracture treated by our group with two different therapeutic plans: (1) conservative treatment after hardware removal (group A) and (2) arthroscopic intervention with hardware removal (group B) were prospectively studied. Patients were reviewed preoperatively and 6, and 12 months postoperatively using American Foot and Ankle Society (AOFAS) scale and VAS score. The patients were followed up in a mean period of 2.4 years (range; 1-4 years). The hardware removal with or without arthoscopy were performed 12 to 15 months after the ankle fracture.
Results: The VAS score were statistically significant improved from an M=4.7 (3-5) pre- to M=1.2 (0-2) in 6 months post- and to M=0.9 (0-2) in 1 year post-operatively in Group A and from an M=4.8 (3-5) pre- to M=0.9 (0-2) in 6 months post- and to M=0.6 (0-2) in 1 year post-operatively in Group B (p< 0,001). Median AOFAS scores improved from 72 (66-80) points to 78 (73-94) points in group A and from 74 (64-80) points to 89 (72-100) points in group B, and this improvement was significantly higher for patients in group B (p = 0.001).
Conclusions: Chronic pain after healed ankle fracture due to loose body, bony impingement, or anterolateral soft-tissue impingement should be arthroscopically treated with hardware removal as it has a better outcome than hardware removal and conservative treatment.
Ankle arthroscopy combined with hardware removal for chronic pain after ankle fracture

ePoster - epAFAS-02

Topic: Arthroscopy

Nikolopoulos D.1, Safos G.1, Moustakas K.1, Anastasiou I.1, Safos P.2, Siderakis A.2, Fragkomichalos E.3
1Central Clinic of Athens, Orthopaedic, Athens, Greece, 2Ikaria General Hospital, Orthopaedic, Ikaria, Greece, 3General Hospital of Chios, Orthopaedic, Chios, Greece

Introduction: Ankle fractures (unstable) are commonly treated by orthopaedic surgeons with open reduction and internal fixation (ORIF). After the fracture healing, many patients complaint about localized chronic ankle pain caused by hardware irritation, osteophytes, intraarticular damage, or caused by synovitis or arthrofibrosis; that's why request to remove hardware, expecting pain relief. Such ongoing pain may result from intra-articular injury sustained at the time of fracture or anterolateral soft-tissue impingement or synovitis that developed after the fracture.
Objectives: The purpose of this study is to evaluate the effectiveness of arthroscopy combined with hardware removal for chronic pain after satisfactory healing of an ankle fracture.
Aim: It is hypothesized that combining hardware removal with arthroscopy for the intra-articular pathology would improve residual complaints more so than hardware removal alone.
Methods: The last decade, the outcomes of the 144 patients (78 male vs 66 female) of mean age 33,2 years old (range 16 to 55) with chronic pain after healed ankle fracture treated by our group with two different therapeutic plans: (1) conservative treatment after hardware removal (group A) and (2) arthroscopic intervention with hardware removal (group B) were prospectively studied. Patients were reviewed preoperatively and 6, and 12 months postoperatively using American Foot and Ankle Society (AOFAS) scale and VAS score. The patients were followed up in a mean period of 2.4 years (range; 1-4 years). The hardware removal with or without arthoscopy were performed 12 to 15 months after the ankle fracture.
Results: The VAS score were statistically significant improved from an M=4.7 (3-5) pre- to M=1.2 (0-2) in 6 months post- and to M=0.9 (0-2) in 1 year post-operatively in Group A and from an M=4.8 (3-5) pre- to M=0.9 (0-2) in 6 months post- and to M=0.6 (0-2) in 1 year post-operatively in Group B (p< 0,001). Median AOFAS scores improved from 72 (66-80) points to 78 (73-94) points in group A and from 74 (64-80) points to 89 (72-100) points in group B, and this improvement was significantly higher for patients in group B (p = 0.001).
Conclusions: Chronic pain after healed ankle fracture due to loose body, bony impingement, or anterolateral soft-tissue impingement should be arthroscopically treated with hardware removal as it has a better outcome than hardware removal and conservative treatment.
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