Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2016; 7(4): 258-264
Published online Apr 18, 2016. doi: 10.5312/wjo.v7.i4.258
Ankle fracture configuration following treatment with and without arthroscopic-assisted reduction and fixation
Chayanin Angthong
Chayanin Angthong, Department of Orthopaedics, Faculty of Medicine, Thammasat University, Klong Luang 12120, Pathum Thani, Thailand
Author contributions: Angthong C designed and performed the research, analyzed the data and wrote the paper.
Institutional review board statement: This study (study code: MTU-EC-OT-0-099/54) was approved by the institutional review board of the Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
Informed consent statement: All involved participants gave their informed consent prior to study inclusion.
Conflict-of-interest statement: The author received the funding supports for academic meetings and visit from Smith and Nephew LTD (Thailand) and Device Innovation (Arthrex distributor in Thailand).
Data sharing statement: The original dataset is available on request from the corresponding author at
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Chayanin Angthong, MD, PhD, Department of Orthopaedics, Faculty of Medicine, Thammasat University, Klong Luang 12120, Pathum Thani, Thailand.
Telephone: +66-2-9269775 Fax: +66-2-9269793
Received: May 9, 2015
Peer-review started: May 11, 2015
First decision: July 27, 2015
Revised: December 10, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: April 18, 2016

AIM: To report ankle fracture configurations and bone quality following arthroscopic-assisted reduction and internal-fixation (ARIF) or open reduction and internal-fixation (ORIF).

METHODS: The patients of ARIF (n = 16) or ORIF (n = 29) to treat unstable ankle fracture between 2006 and 2014 were reviewed retrospectively. Baseline data, including age, sex, type of injury, immediate postoperative fracture configuration (assessed on X-rays and graded by widest gap and largest step-off of any intra-articular site), bone quality [assessed with bone mineral density (BMD) testing] and arthritic changes on X-rays following surgical treatments were recorded for each group.

RESULTS: Immediate-postoperative fracture configurations did not differ significantly between the ARIF and ORIF groups. There were anatomic alignments as 8 (50%) and 8 (27.6%) patients in ARIF and ORIF groups (P = 0.539) respectively. There were acceptable alignments as 12 (75%) and 17 (58.6%) patients in ARIF and ORIF groups (P = 0.341) respectively. The arthritic changes in follow-up period as at least 16 wk following the surgeries were shown as 6 (75%) and 10 (83.3%) patients in ARIF and ORIF groups (P = 0.300) respectively. Significantly more BMD tests were performed in patients aged > 60 years (P < 0.001), ARIF patients (P = 0.021), and female patients (P = 0.029). There was no significant difference in BMD test t scores between the two groups.

CONCLUSION: Ankle fracture configurations following surgeries are similar between ARIF and ORIF groups, suggesting that ARIF is not superior to ORIF in treatment of unstable ankle fractures.

Keywords: Arthroscopy, Ankle, Fractures, Fracture fixation, Bone densitometry reports

Core tip: There was no significant difference between arthroscopic-assisted reduction and internal-fixation (ARIF) and open reduction and internal-fixation (ORIF) in immediate-postoperative ankle fracture configuration in the present study. Although the use of arthroscopy in orthopaedic trauma is increasing, the effectiveness of ARIF compared with that of ORIF in the management of ankle fractures has yet to be verified. The low rate of bone mineral density testing reflects a lack of awareness of the need for routine post-injury testing for osteoporosis in patients with ankle fractures.