| Objective To compare the clinical outcomes of displaced posterior malleolar fractures treated with arthroscopy-guided percutaneous screw fixation and open reduction via posterolateral approach.Methods A retrospective analysis was conducted on the clinical data of 48 patients with ankle fractures combined with posterior malleolar fractures, who had underwent surgical treatment at Wuhan Fourth Hospital from December 2017 to December 2020. There were 39 males and 9 females, with a mean age of 45.5 years (range, 32-74 years). According to the different surgical methods of posterior malleolus fracture fragments, 21 cases were treated with percutaneous reduction and screw fixation under ankle arthroscopy (arthroscopic group), and 27 cases were treated with open reduction and fixation via posterolateral approach (open group). The duration of tourniquet application, bone healing time, imaging evaluation, American Orthopaedic Foot and Ankle Society ankle and hindfoot score (AOFAS) and surgery-related adverse reactions were compared between the two groups.Results Forty-eight patients were followed up for 6-12 months, with an average of (8.23±1.56) months. The duration of tourniquet application in the arthroscopic group [(77.7±12.3) min] was longer than that in the open group [(66.8±11.2) min], but the difference was not statistically significant (P>0.05). The bone healing time was (9.4±2.3) weeks in arthroscopic group and (10.2±3.1) weeks in open group (P>0.05). In the arthroscopic group, postoperative CT showed that the intra-articular step was more than 2 mm in 3 patients, and 7 cases in the open group. The AOFAS ankle-hindfoot score was (80.6±8.4) scores in the arthroscopic group, which was higher than (70.5±5.7) scores in the open group (P<0.05).Conclusion Compared with open reduction via posterolateral approach, posterior arthroscopic percutaneous reduction and screw fixation has the advantages of more accurate reduction, less soft tissue injury, better functional recovery of foot and ankle and less surgery-related adverse events. It is an alternative and effective treatment option. |
