Arthroscopically assisted (AORIF) ankle fracture treatment seems to lead to superior results when compared to open reduction and internal fixation (ORIF) only: results of a systematic review

Ankle fractures often involve intra-articular pathologies, which can only be addressed by additional arthroscopy. This systematic review aims to compare the outcomes of arthroscopically assisted open reduction and internal fixation (AORIF) with traditional open reduction and internal fixation (ORIF) for ankle fractures. A systematic literature search adhering to PICOS and PRISMA guidelines was conducted across the following databases: MEDLINE (PubMed), Scopus, Central and EMBASE. Studies that compared AORIF and ORIF of ankle fractures and focused on patient-reported outcome measures (PROMs) as the primary outcome were included. Excluded were studies on non-acute or non-isolated fractures, pilon fractures, concomitant injuries outside the ankle, biomechanical or computational studies, and those lacking objective outcome data. A total of 7089 studies were screened, 12 of which met the inclusion criteria for qualitative synthesis. The level of evidence was I-III with a mean MINORS Tool score of 19.17. Among the included studies, six studies focused on unimalleolar fractures, with four demonstrating significantly better PROMs for the AORIF group. Five studies addressed bimalleolar and/or trimalleolar fractures, with one showing significantly better PROMs for AORIF. Seven studies reported on intra-articular pathologies, with a detection rate of up to 88.89%. Two out of three studies on posttraumatic arthritis indicated lower grades of osteoarthritis in the AORIF group. The review suggests that AORIF may lead to improved scores as obtained through various PROMs compared to ORIF, particularly for unimalleolar fractures. However, the heterogeneity among the underlying studies indicates the need for further research to identify specific patient populations and fracture types that would benefit the most from AORIF.