Diagnosis and treatment of combined intra-articular disorders in acute distal fibular fractures

BACKGROUND: Some patients have residual ankle pain and disability after the treatment of an ankle fracture, despite the fracture site being well aligned. We identified intra-articular disorders in distal fibular fractures and sought to clarify the results of their operative treatment. METHODS: This is a prospective, randomized study. Seventy-two patients with Weber type B distal fibular fractures were randomly treated with arthroscopy-assisted open reduction and internal fixation (AORIF) or with open reduction and internal fixation without arthroscopy (ORIF). In the AORIF group, the patients were followed for a mean duration of 3 years 4 months (range, 2 years 4 months-4 years 5 months). There were 27 male patients and 14 female patients. The mean age of the patients at the time of surgery was 36 years (range, 20-64 years). In the ORIF group, the patients were followed for a mean duration of 3 years 5 months (range, 2 years 7 months-4 years 5 months). There were 21 male patients and 10 female patients. The mean age of the patients at the time of surgery was 38 years (range, 20-58 years). We described intra-articular disorders in the AORIF group using ankle arthroscopy and compared their operative results with those of the ORIF group. RESULTS: Including duplication, the arthroscopic findings showed 30 cases with osteochondral lesions of the talar dome (73.2%) and 33 cases with tibiofibular syndesmosis disruptions (80.5%). Six cases (14.6%) had no combined disorders. The mean AOFAS score was 91.0 +/- 3.5 (range, 85-100) in the AORIF group, in contrast to 87.6 +/- 5.5 (range, 77-97) in the ORIF group (p = 0.0106). CONCLUSION: In the treatment of distal fibular fractures, precisely diagnosing and treating the combined intra-articular disorders is important for gaining satisfactory clinical results.