Evaluación artroscópica de lesione intrarticulares em fracturas inestables de tobillo

Abstract

Several residual symptoms such as recurrent swelling, chronic pain and perceived instability have been described following an ankle fracture and it may be related to a concomitant chondral injury. The aim of this study was to determine arthroscopically the prevalence of intra-articular lesions in patients with acute ankle fractures and if the severity of the fractures is correlated with an increased number of articular surface lesions (osteochond ral and chondral defects). Methods: we conducted a prospective case series. From 2004 to 2007, 104 patients with acute unstable ankle fractures were randomized to underwent an arthroscopy followed by open reduction and internal fixation(AORIF) or open reduction and internal fixation alone (ORlF). The fractures were classified according Lauge-hansen and Danis Weber schemes. Thirty three Weber B and seventy one Weber C fractures were included. Patients with neurovascular lesion, severe swelling or open fractures were excluded. Results: articular surface lesions, including chondral defects and.osteochondral lesions were indentified in 34 (64%) of the 53 patients who underwent AORIF. 0f the 29 chondral defects, 6 (20.6%) were Iocalized to the tibia, 18 (62%) noted on the talar medial surface,3 (10.3%) on talar lateral surface and 2 (6.8%) on the fibula. Of the five osteochondral lesions, 4 involved the medialdome and 1 involved the lateral side. Pin fixation a nd debridement-d rilling were the methods used for management of osteochondral lesions. Conclusions: articular surface lesions have a high incidence in most unstable ankle fractures; arthroscopy is a valious and safe technique in evaluating. and treating those types of lesions that may optim ize functional outcomes. A prospective outcome study will be necessary to correlate these findings to the final health status of the patients.