Arthroscopic Treatment Vs. Open Surgery in Intra-articular Fractures

Abstract

Prior to the introduction of ‘arthroscopy’ for the treatment of articular fractures, they were known as ‘fractures that only require reduction and fixation’. Yet, after the introduction of arthroscopy, we have come to learn that these fractures are not just bony lesions but rather that they accompany a range of injuries that also need to be addressed to obtain better surgical results. Arthroscopic-assisted fracture reduction procedures encompass direct and overall assessment of the joint and allow surgeons to obtain accurate reduction, perform debridement, treat accompanying injuries of the joint, and focus on rectifying other pathologies in accordance with fracture healing. The use of arthroscopically assisted fracture fixation has become increasingly used and reported surgical results appear promising. This procedure has become the gold standard method of surgical treatment for a variety of articular fractures. Notwithstanding these advantages, there are also some limitations and complications associated with this method. The assessment of a traumatic joint is not straightforward, because there may be accompanying fracture haematoma, displaced intra-articular surfaces, and a distorted anatomy that make it difficult to evaluate and address the problem appropriately. Thorough preoperative planning, a good understanding of the aspects of the fracture, and surgical skills, which can be gained after a long training period alongside a surgeon experienced in arthroscopy, are required. Without the necessary surgical skills and arthroscopic devices, fluid extravasation resulting in compartment syndrome, neurovascular damage, and inappropriate treatment of the injury, as well as several other potential complications, may be unavoidable. Arthroscopic-assisted fracture fixation is promising, but further well-done studies, with larger cohorts, are needed.