I was involved in a bad motorcycle accident in Los Angeles. Broke my ankle in three places. Fortunately, I ended up at a large medical/surgical facility where the surgeon did arthroscopic surgery to reconstruct the ankle. I've since heard that arthroscopic ankle surgery isn't available just anywhere. I've had such a great result, I can't help but ask, Why not?
As you have discovered the hard way, arthroscopic reduction and internal fixation (ARIF) of ankle fractures is an emerging procedure. Until now, the complexity of the ankle joint has required an open procedure called open reduction and internal fixation, more commonly known as ORIF.
Arthroscopic surgery is image-guided through a tiny TV camera on the end of the scope. A picture is projected up on a screen for the surgeon to see. This technology makes it possible to reach places in the joint that would require extensive dissection (cutting and opening) to see otherwise.
Arthroscopic surgery is less invasive than an open incision that cuts through soft tissues that protect and stabilize the joint. With less tissue disruption, there is much less swelling and potentially faster healing. One other advantage of arthroscopic ankle surgery is the reduced risk of accidentally cutting a nerve or important blood vessel.
For all those positive factors associated with arthroscopic reduction and internal fixation (ARIF), there are a few disadvantages. The procedure takes longer than an open reduction and internal fixation (ORIF). The risk of complications from anesthesia and surgery itself go up with increased time on the operating table.
In terms of costs, the ARIF is more expensive in the short-term. But if it prevents the chronic pain that can develop after ORIF, ARIF could potentially lower overall costs in the long-run.
There are some procedures for which arthroscopy has been done successfully with good outcomes. There are six conditions for which arthroscopic reduction and internal fixation (ARIF) can be used. These include: 1) transchondral fracture, 2) talar fracture, 3) distal tibial fracture, 4) syndesmotic disruption, 5) malleolar fracture, and 6) chronic ankle pain after treatment. Arthroscopic surgery should not be used when there is a fracture and dislocation.
The most important factor is effectiveness of these two procedures (ORIF and ARIF) when compared against each other. And that's where research has not yet been done. Without the assurance that ARIF is indeed superior to ORIF when treating ankle fractures, most ankle fractures will continue to be managed using the open method.
Patients who go to large teaching or university-based hospitals are more likely to benefit from advanced surgical techniques. Senior, experienced surgeons help guide younger, more junior surgeons learn and practice these skills. Your successful results is a testament to this model. Congratulations! In time, arthroscopic technique will be available on a more routine basis to a larger number of people.
Davide E. Bonasia, MD, et al. The Role of Arthroscopy in the Management of Fractures About the Ankle. In Journal of the American Academy of Orthopaedic Surgeons. April 2011. Vol. 226-235.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.