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Prevalence of intra-articular lesions in acute ankle fractures and predisposing factors for cartilage and ligament injury: A pilot prospective study
ESSKA Academy. Lee S. Nov 8, 2019; 286362
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Prevalence of intra-articular lesions in acute ankle fractures and predisposing factors for cartilage and ligament injury: A pilot prospective study

AFAS Free Papers

Topic: Arthroscopy

Lee S.H., Kweon S.H.
Wonkwang University Hospital, Iksan City, Korea, Republic of

Background: According to previous literature, intra-articular lesions associated with ankle fracture may be the cause of pain and poor prognosis following appropriate surgical treatment. We undertook a prospective pilot study to determine the prevalence of intra-articular lesions in acute ankle fractures. In addition, we evaluate the risk factors which were related to intra-articular lesions.
Method: From 2017 to 2018, 40 consecutive patients with acute unstable ankle fractures underwent ankle arthroscopy followed by reduction and internal fixation. We have evaluated prospectively the arthroscopic findings in acute fractures of the ankle in 40 consecutive patients (22men and 18 women) with a mean age of 49.8 (17-77) years. In addition, all injuries were categorized by specific osseous, ligamentous, and articular pathology, based on clinical and arthroscopic examination. Presence of subluxation of ankle joint was also evaluated. Multivariate logistic analysis was performed for the evaluation of risk factors of osteochondtal lesion of talus and ligament injuries.
Results: Traumatic chondral defects and osteochondral lesions of talus (OLT) were identified in 20 of the 40 ankles (60.0%). Of the 12 pronation-external rotation (PER) fractures, 7 had articular surface defects with 6 involving the medial and 1 the lateral dome (p< 0.05). Thirteen of the 22 supination-external rotation (SER) or Danis-Weber B fractures were found to have TASLs of the talus, 4 medial and 9 lateral (p>0.05). Medial ligament complex injuries including deep deltoid ligament were found in 7 (17.5%) patients. Of these medial ligament injuries, 5 were included SER type and 2 were included PER type. Anterior talofibular ligament (ATFL) were injured in 13 (42.5%) patients. Of these lateral ligament injuries, 2 were included SER type, 2 were included PA type and 9 were included PER type. For the risk factors, chondral lesion was significantly affected by the subluxation of ankle joint (p=0.013; adjusted odds ratio, OR, ≥ 30, 5.2) and ATFL injury was affected by pronation type injuries (p=0.021, adjusted OR 6.3). The other variables were not found to be significant risk factors.
Conclusions: Ankle fractures have a high incidence of concomitant intra-articular pathology with ankle subluxation portending a particularly high risk of articular surface injury to the talar dome. In addition, appropriate evaluation and rehabilitation would necessary for ATFL injury in pronation type of fracture.
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