Short Term Post-Operative Outcomes for Ankle Fracture Fixation With or Without Ankle Arthroscopy: A Database Study

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Ankle fractures are among the most frequently treated orthopedic injuries. Although open reduction and internal fixation (ORIF) remains the gold standard, about 20% of patients report poor outcomes. Evidence suggests that these results are not due to inadequate fracture reduction but rather to undiagnosed and untreated intra-articular injuries. Therefore, ankle arthroscopy in conjunction with ORIF has gained popularity as a means of improving surgical and diagnostic outcomes. While recent research has compared patient-reported outcomes in ORIF plus arthroscopy versus traditional ORIF, short-term post-operative complications have not been investigated. Therefore, we examined short-term complications in both groups, hypothesizing that ORIF plus arthroscopy would demonstrate no significant increase in complications compared to ORIF alone, potentially supporting the routine addition of arthroscopy in treatment of ankle fractures. Methods: In this National Surgical Quality Improvement Program (NSQIP) database study, we included all ankle fracture cases treated with ORIF from 2010 to 2023. Cases were identified using Current Procedural Terminology (CPT) codes: the traditional ORIF group included the code 27829, while the ORIF plus arthroscopy group included 27829 in addition to one of the following ankle arthroscopy codes: 29891, 29892, 29894, 29895, 29897, 29898, 29899. After identifying the relevant cases, groups were matched 1:1 by nearest neighbor propensity score to balance baseline characteristics (age, BMI, sex, race, ASA class, and key comorbidities). For statistical analysis, continuous variables were compared using the Wilcoxon test, and categorical variables were compared using the chi-square test. Finally, the risk of short-term complications for both groups was assessed via odds ratio calculations. Results: After matching, a total of 494 patients were in each group. No difference in major post-operative complications (p = 0.281), infection (p = 0.77), and return operating room (p = 0.29). The total operating time was 18.3 minutes longer for the ORIF plus arthroscopy group (p < 0.001). However, arthroscopic patients had significantly higher rates of outpatient procedures and shorter length of hospital stay (p < 0.001). Regarding risk of complication, no demographic-related factor was significantly correlated with adverse events for the ORIF plus arthroscopic group. However, increased age and time from admission to operation presented a significant risk of complications for the traditional ORIF group (p < 0.05). A summary of results can be found in Figure 1. Conclusion: In conclusion, ORIF plus arthroscopy leads to no differences in short term post-operative complications compared to traditional ORIF. While adding arthroscopy added an additional 18 minutes to total operative time, this time may allow for thorough assessment of any possible intra-articular injuries, possibly improving outcomes. The strength of this study lies in the sample size, including nearly 1000 patients. However, future assessment of long-term outcomes is needed to determine if ORIF plus arthroscopy improves patient-reported outcomes.