Arthroscopically-assisted Reduction and Internal Fixation (ARIF) vs Percutaneous Fixation in Talar Fractures: A Systematic Review of the Literature

Research Type: Level 4 – Case series Introduction/Purpose: Arthroscopically-assisted Reduction and Internal Fixation (ARIF) in acute trauma is progressively gaining popularity in foot and ankle surgery. The purpose of this study was to determine whether ARIF for talar fractures influences the healing and complication rate as compared to percutaneous fixation (PF). We hypothesized that ARIF might increase the radiographic healing rate and reduce the number of complications in this setting. Methods: Following the PRISMA checklist, the Medline, Scopus, Web of Science and Cochrane databases were searched, including studies reporting on patients diagnosed with a talar fracture undergone minimally-invasive surgery using screws as exclusive fixation method. We extracted data regarding the cohort (sample size, age, sex, aetiology), the study design (type of study, level of evidence), the surgical technique (length of surgery, with or without arthroscopy, number of screws) and the outcome (radiographic healing, complication rate, early peritalar osteoarthritis) at the longest follow-up. The methodological items for non-randomized studies (MINORS) were used to assess the methodological quality of studies. Results after ARIF were compared with PF. Results: Eight studies (124 talar fractures) were selected (ARIF=73, PF=51). In the two groups, the mean (±SD) sample size (18.2±10.2 for ARIF and 12.7±9.3 in G2; p=0.88), mean age of patients (36.7±3.8 for ARIF and 34.2±2.1; p=0.24) and sex distribution (44% females and 30% females; p=0.47) were comparable. The mean follow-up was shorter in ARIF (18±12.9 months) than in PF (46.7±3.8 months) but the difference was not significant (p=0.09). The healing rate assessed on radiographs was similar (99%±1 in ARIF vs 98%±3 in PF) in the two groups (p=0.85). The complication rate did not differ either (13%±9 in ARIF vs 25%±17 in PF; p=0.19). The incidence of early peritalar osteoarthritis was significantly lower in ARIF (3%±3 vs 16%±5; p=0.04). Conclusion: In this review, we found a similar radiographic healing rate and complication rate in talar fractures treated percutaneously using screws with or without arthroscopy. The incidence of early peritalar osteoarthritis was significantly lower after ARIF than after standalone percutaneous fixation. Figure 1 Box and whisker plot comparing the healing rate, the complication rate and the incidence of early peritalar osteoarthritis in patients diagnosed with a talas fracture undergone arthroscopically-assisted Reduction and Internal Fixation (ARIF) or percutaneous fixation (PF).