Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 9, pp 1287–1292 | Cite as

Arthroscopic assessment of medial malleolar reduction

  • Eric F. Swart
  • J. Turner Vosseller
Arthroscopy and Sports Medicine



Ankle fractures treated with open reduction internal fixation are fixed in an effort to reestablish anatomic bony alignment and avoid a malunion, thereby diminishing the risk of post-traumatic arthritis. For a medial malleolar fracture, an articular step-off is likely more related to the risk of post-traumatic arthritis than is a cortical step-off. However, the external cortical alignment is often used to judge the adequacy of reduction, as the articular component of the fracture is not as readily visualized. Arthroscopy has been used in various articular fractures as an aid to diagnosis and treatment. The current study prospectively assessed both the quality of medial malleolar reduction on the articular side using arthroscopy and the adequacy of using cortical cues to guide the articular reduction.


Twelve consecutive patients were enrolled in this prospective diagnostic study. All patients had medial malleolar fractures that required fixation. The outcome variables of interest were extra-articular fracture displacement and articular surface displacement.


After reduction and provisional fixation, 10 of the 12 patients had an anatomic reduction based on cortical cues. On arthroscopy 7 of the 12 patients had an anatomic reduction. Four of the patients had a slight gap (<1 mm) at the anterior edge of the fracture. The last patient had an anterior gap just under 2 mm. Two patients had impaction of the medial malleolus that made reduction difficult and was recognized during arthroscopy after obtaining a reduction based on cortical cues.


The cortical reduction of the medial malleolus often matched up with the articular reduction. However, in some patients, impaction of the medial malleolus made it so that the two did not match up. There are some cases in which extra-articular cues are insufficient to evaluate for intra-articular reduction.


Ankle fracture Medial malleolar fracture Arthroscopy Articular reduction 


Conflict of interest

The author(s) declare no potential conflicts of interest or relevant financial relationships with respect to the research, authorship, and/or publication of this article.


  1. 1.
    Bonasia DE, Rossi R, Saltzman CL, Amendola A (2011) The role of arthroscopy in the management of fractures about the ankle. J Am Acad Orthop Surg 19(4):226–235PubMedGoogle Scholar
  2. 2.
    Schuberth JM, Collman DR, Rush SM, Ford LA (2004) Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments. J Foot Ankle Surg 43(1):20–29PubMedCrossRefGoogle Scholar
  3. 3.
    Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B (2010) Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg [Am]. 92(2):279–286CrossRefGoogle Scholar
  4. 4.
    Leontaritis N, Hinojosa L, Panchbhavi VK (2009) Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg [Am]. 91(2):333–339CrossRefGoogle Scholar
  5. 5.
    Aktas S, Kocaoglu B, Gereli A, Nalbantodlu U, Gϋven O (2008) Incidence of chondral lesions of talar dome in ankle fracture types. Foot Ankle Int 29(3):287–292PubMedCrossRefGoogle Scholar
  6. 6.
    Lui TH, Ip K, Chow HT (2005) Comparison of radiologic and arthroscopic diagnoses of distal tibiofibular syndesmosis disruption in acute ankle fracture. Arthroscopy 21((11)):1370.e1–1370.e7Google Scholar
  7. 7.
    Holt ES (1994) Arthroscopic visualization of the tibial plafond during posterior malleolar fracture fixation. Foot Ankle Int 15(4):206–208PubMedCrossRefGoogle Scholar
  8. 8.
    Whipple TL, Martin DR, McIntyre LF, Meyers JF (1993) Arthroscopic treatment of triplane fractures of the ankle. Arthroscopy 9(4):456–463PubMedCrossRefGoogle Scholar
  9. 9.
    Imade S, Takao M, Nishi H, Uchio Y (2004) Arthroscopy-assisted reduction and percutaneous fixation for triplane fracture of the distal tibia. Arthroscopy 20(10):e123–e128PubMedCrossRefGoogle Scholar
  10. 10.
    Panagopoulos A, van Niekerk L (2007) Arthroscopic assisted reduction and fixation of a juvenile Tillaux fracture. Knee Surg Sports Traumatol Arthrosc 15:415–417PubMedCrossRefGoogle Scholar
  11. 11.
    Varitimidis SE, Basdekis GK, Dailiana ZH, Hantes ME, Bargiotas K, Malizos K (2008) Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction? J Bone Joint Surg [Br]. 90(6):778–785CrossRefGoogle Scholar
  12. 12.
    Ono H, Furuta K, Fujitani R, Katayama T, Akahane M (2010) Distal radius fracture arthroscopic intraarticular displacement measurement after open reduction and internal fixation from a volar approach. J Orthop Sci. 15(4):502–508PubMedCrossRefGoogle Scholar
  13. 13.
    Rammelt S, Gavlik JM, Barthel S, Zwipp H (2002) The value of subtalar arthroscopy in the management of intra-articular calcaneus fractures. Foot Ankle Int 23(10):906–916PubMedGoogle Scholar
  14. 14.
    Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A (2005) Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 25:44–46PubMedCentralPubMedGoogle Scholar
  15. 15.
    Tejwani NC, McLaurin TM, Walsh M, Bhadsavle S, Koval KJ, Egol KA (2007) Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? J Bone Joint Surg [Am]. 89:1438–1441CrossRefGoogle Scholar
  16. 16.
    Stufkens SAS, Knupp M, Lampert C, van Dijk CN, Hintermann B (2009) Long-term outcome after supination-external rotation type-4 fractures of the ankle. J Bone Joint Surg [Br] 91-B:1607–1611CrossRefGoogle Scholar
  17. 17.
    Thordarson DB, Bains R, Shepherd LE (2001) The role of ankle arthroscopy on the surgical management of ankle fractures. Foot Ankle Int 22(2):123–125PubMedGoogle Scholar
  18. 18.
    Loren GL, Ferkel RD (2002) Arthroscopic assessment of occult intra-articular injury in acute ankle fractures. Arthroscopy 18(4):412–421PubMedCrossRefGoogle Scholar
  19. 19.
    Hintermann B, Regazzoni P, Lampert C, Stutz G, Gächter A (2000) Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg [Br] 82-B:345–351CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Division of Foot and Ankle Surgery, Department of Orthopaedic SurgeryColumbia University Medical CenterNew YorkUSA

Personalised recommendations