Why is Arthroscopy Essential in Treating Ankle Fractures?

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Why is Arthroscopy Essential in Treating Ankle Fractures?

Why is Arthroscopy Essential in Treating Ankle Fractures?

You, or someone you love sustained an ankle fracture. It’s emotional, painful and time is of urgency. How important is seeking out the proper orthopedic surgeon? Is it okay to trust the emergency room’s referral?

Understanding the need for proper treatment first involves comprehension of the injury and anatomy involved. An ankle fracture refers to a break in the integrity of one or both of the two lower leg bones, the tibia, and fibula, at their lower portion. These fractures may result from minor twisting during which the body and leg rotate in opposite directions. Or, they may be due to severe trauma such as a steep fall or car accident. Of the two general categories, the impact trauma is associated with a poorer prognosis of long-term recovery.

How are Ankle Fractures Typically Treated?
Some fractures of the ankle can be treated with time in a cast or boot. However, many require a more complex method of repair. This repair is known as an ORIF surgery, Open Reduction and Internal Fixation Surgery. This surgical repair involves the temporary or permanent placement of metal screws, pins, rods and/or plates to stabilize the broken bones. ORIF is utilized when the fracture sustained wouldn’t heal correctly with a cast, splint or boot alone. This includes compound fractures, those in which the bone has broken through the skin, as well as fractures that cannot be stabilized without surgery.

The fracture doctor you select will assess the injury using x-rays, MRI’s and/or CT scans as well as a physical examination. Your broken ankle has to be thoroughly visualized and evaluated before an adequate plan of care can be formulated. No one fracture is identical, neither is the stressors you place on your ankle identical to someone else. Therefore, the recommended repair must be individualized to the damage in your ankle. This is where selecting a thoroughly trained, highly recommended surgeon becomes essential.

What Are the Limitations of Traditional Fracture Repair?
Current research is clearly demonstrating the limitations of ORIF surgery. An article dated February 16, 2015 from the National Institute of Health archives (www.ncbi.nim.nih.gov/pmc/articles/PMC4427646,) quotes 20% of ankle fractures undergoing ORIF surgery alone fail to achieve good or excellent results despite adequate fracture reduction on imaging. This article goes on to conclude that the limitations of traditional surgical techniques fail to assess intra-articular damage. This is the damage inside the joint itself. It may be trauma to the cartilage or other internal structures that are not visualized during ORIF surgery.

Why is Intra-Articular Visualization Important in Ankle Fracture Results?
You have certainly heard that injuries result in arthritis. Arthritis is always expected after an injury as severe as a broken ankle, right? Research is showing us that arthritis does not have to be a foregone conclusion of ankle fractures. Trauma that causes a bone to break is hard to accomplish without damaging the other structures associated with the area. This includes the muscles, tendons, ligaments, cartilage, and joint capsule. Also known as soft tissue damage, this was thought to be secondary to the importance of fracture healing. And, it is. Without bone stability, you aren’t even able to walk. However, the soft stuff matters, too. Joint cartilage is often where the first signs of degenerative arthritis are seen. It cannot be adequately visualized on an x-ray that only shows bone. Research is demonstrating improved short and long-term benefits of repairing the intra-articular structures. There is no cure for degenerative arthritis. Prevention is key.

How is Arthroscopy Performed?
Arthroscopic repair of an ankle fracture does not require a distinct and separate surgical procedure. In fact, unless your bone doctor informs you of its performance, most people wouldn’t even notice. The surgery requires tiny incisions that allow the insertion of scope to visualize your ankle. Repairing any damage visualized requires 1 to 3 more small incisions to allow the insertion of the instruments. These are typically much smaller incisions than those required for the ORIF procedure. Occasionally, the doctor will see damage that requires a larger, open repair. Again, it is much easier to perform during the initial surgery than at a later date. Arthroscopic correction does not extend the recovery time of ankle fracture healing.

Why Should I Insist on Arthroscopy for My Ankle Fracture?
Intra-articular structures are only visualized during the ORIF surgery if arthroscopy is performed in concurrently. These internal structures such as loose fragments and displaced or torn tissue cause pain. More importantly, the body enters the healing process which causes fibrosis or scar formation. This process can interfere with healing, cause alterations to the normal joint structure, as well as cause a loss of proper joint function. To ensure a return to Your Normal, insist on full repair of the injuries sustained.

The use of arthroscopy in ankle fractures is not routine. However, surgeons who are confident in the latest research are making it a mandatory component of their ankle fracture repair. Utilizing this low-risk, low-cost intervention is yielding long-term clinical functioning benefits. Optimize your ankle fracture outcome by insisting on the best in fracture repair. Talk to your physician today for individualized details.