Arthroscopy in Acute Ankle Fractures: A Weber Classification-Based Analysis

Abstract

Ankle fractures are common orthopedic injuries, often treated with open reduction and internal fixation (ORIF). However, 21% to 45% of patients report unsatisfactory outcomes, possibly due to intraarticular pathology. This study aimed to assess these injuries arthroscopically and statistically analyse their prevalence and relation to the Weber classification. A prospective cohort study was conducted on 48 patients with acute ankle fractures at the University Clinic for Surgical Diseases “St. Naum Ohridski” from January 2020 to January 2023. Patients underwent standard preoperative radiographic examinations and were classified according to the Weber classification, followed by arthroscopic intraarticular examination and ORIF. The arthroscopic examination evaluated syndesmotic injury, chondral lesions, loose bodies, and deltoid ligament injuries. Forty-eight patients were studied, with intraarticular pathology found in 33 cases (68.75%). For Weber fractures: type A had 58.33%, type B had 72.73%, and type C had 84.21% of intraarticular pathology. Syndesmotic injury appeared in 33.33% of type A, 50% of type B, and 41.67% of type C fractures. Chondral lesions occurred in 41.67% of type A, 54.55% of type B, and 66.67% of type C fractures. Loose bodies were detected in 8.33% of type A, 18.18% of type B, and 25% of type C fractures. Deltoid ligament injuries were observed in 16.67% of type A, 27.27% of type B, and 41.67% of type C fractures. The study concludes that arthroscopy during ORIF in ankle fractures is valuable for diagnosing intraarticular pathology. It highlights the Weber classification's importance, noting that type C fractures have a higher chance of such involvement. Understanding arthroscopy's diagnostic value in these cases helps surgeons decide on concurrent interventions during ORIF, potentially improving patient outcomes. Further research may investigate how arthroscopy-guided interventions affect clinical outcomes.