Arthroscopic Targeted Screw Placement: A Minimally Invasive Approach for Hindfoot Fractures

Arthroscopic techniques have emerged as a promising alternative to traditional open reduction internal fixation in the treatment of foot and ankle fractures, offering minimally invasive methods to address intra-articular fractures. These techniques provide direct visualization of the fracture site while preserving the soft tissue envelope and osseous blood supply, mitigating risks associated with open surgical approaches such as infection, malunion, and soft tissue complications. This Technical Note highlights the surgical technique and applications of arthroscopic targeted screw placement (ATSP) for talus fractures, trimalleolar ankle fractures, and distal tibia fractures. Utilizing preoperative imaging for surgical planning, the procedure involves arthroscopic reduction, debridement, and minimally invasive fixation under fluoroscopic guidance. Advantages of ATSP include reduced operative morbidity, earlier mobilization, and detection of subtle intra-articular injuries often missed by conventional methods. However, barriers to widespread adoption include the learning curve, costs of arthroscopic equipment, and the need for specialized training. Despite these challenges, arthroscopic techniques have shown improved functional outcomes, reduced postoperative pain, and lower complication rates compared to open reduction internal fixation. This Technical Note describes ATSP in detail, outlining its potential applications, procedural steps, pearls, pitfalls, and considerations for cost and training.