Arthroscopically Assisted Surgery for Ankle Fractures

Ankle fractures are a prevalent orthopedic injury that can significantly affect a patient’s mobility and quality of life. Traditional treatment methods, such as open reduction and internal fixation (ORIF), have been the standard approach for many years. However, with advancements in medical technology, arthroscopy has emerged as a beneficial adjunctive tool in the surgical management of these fractures. This article will explore the benefits, clinical outcomes, and current evidence supporting the use of arthroscopy in treating ankle fractures.

How Common It Is and Who Gets It? (Epidemiology)

Ankle fractures are common injuries that affect people of all ages. They occur more frequently in active individuals, especially athletes or those involved in high-impact activities. Ankle fractures are also more common in older adults due to falls or weakened bone structure. In recent years, arthroscopically assisted surgery has become increasingly popular as an option for patients with complex fractures, especially those with concomitant injuries that may not be visible through traditional methods.

Why It Happens – Causes (Etiology and Pathophysiology)

Ankle fractures usually result from trauma, such as:

• Falls: Accidental falls, especially in older adults, often lead to fractures.

• Sports Injuries: High-impact sports can cause fractures from twists, turns, or direct blows to the ankle.

• Car Accidents: In severe trauma, the ankle may be subjected to extreme forces, leading to fractures.
  These fractures can range from simple breaks to complex fractures that involve multiple bones or joint dislocations. When multiple injuries occur, arthroscopy can be used to visualize and treat all the associated damage, leading to better functional recovery.

How the Body Part Normally Works? (Relevant Anatomy)

The ankle joint connects the tibia, fibula, and talus, allowing the foot to move up and down. It is stabilized by ligaments, tendons, and cartilage that protect the joint and allow smooth movement. Ankle fractures may involve any of these components, and depending on the fracture’s complexity, damage to surrounding ligaments or cartilage may occur. Arthroscopy allows surgeons to see inside the joint and treat these injuries while minimizing tissue disruption.

What You Might Feel – Symptoms (Clinical Presentation)

Symptoms of an ankle fracture include:

• Sudden, severe pain in the ankle

• Swelling, bruising, or tenderness around the ankle joint

• Decreased range of motion or inability to move the foot

• A visible deformity or abnormal positioning of the foot

• In cases of concomitant injuries, such as ligament tears, there may also be instability or a feeling of the ankle “giving way.”

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis is made through a physical exam and imaging studies:

• X-rays: The most common imaging method, X-rays help determine the type and extent of the fracture.

• CT scans: Provide more detailed images of complex fractures to guide surgical planning.

• MRI: Used to detect soft tissue damage, such as ligament tears or cartilage injury, that may not be visible on X-rays.

• Arthroscopy: In some cases, arthroscopy may be used directly during surgery to visualize the fracture and any hidden injuries, such as damaged cartilage or ligaments.

Classification

Arthroscopically assisted surgery for ankle fractures is typically used in complex cases, including:

• Pilon Fractures: Severe fractures involving the lower end of the tibia.

• Ankle Fractures: Common fractures involving the tibia, fibula, or both.

• Calcaneus Fractures: Fractures of the heel bone that affect the stability and function of the ankle.

Other Problems That Can Feel Similar (Differential Diagnosis)

Conditions that may be confused with ankle fractures include:

• Achilles Tendonitis: Pain at the back of the ankle that may be mistaken for fracture-related discomfort.

• Sprains: Ligament injuries can mimic the symptoms of fractures, including pain and swelling.

• Subtalar Joint Dysfunction: Issues with the joint below the ankle can cause pain and instability similar to ankle fractures.
  Differentiating these conditions from fractures is essential, and further imaging or arthroscopic surgery may be needed for accurate diagnosis and treatment.

Treatment Options

Non-Surgical Care

• Casting or Splinting: Used for stable fractures that don’t require surgery.

• Physical Therapy: Helps restore strength, flexibility, and range of motion after fractures heal.

• Medications: NSAIDs for pain and inflammation.

• Bracing: Can be used to stabilize the ankle after a fracture has healed.

Surgical Care

• Open Reduction and Internal Fixation (ORIF): A traditional procedure where the fracture is realigned and stabilized using plates, screws, or rods.

• Arthroscopically Assisted Open Reduction and Internal Fixation (AAORIF): A more advanced technique that uses arthroscopy to aid in fracture alignment and identify hidden injuries like cartilage damage or ligament tears.

• External Fixation: In cases of severe fractures, an external device may be used to stabilize the ankle.

Recovery and What to Expect After Surgery (Recovery Process)

After surgery, recovery typically involves:

• Postoperative Immobilization: Wearing a cast or boot to protect the ankle for several weeks.

• Restricted Weight-Bearing: Initially, patients must avoid putting weight on the ankle, using crutches or a walker for mobility.

• Physical Therapy: A rehabilitation program begins once healing allows. The focus will be on restoring strength, range of motion, and stability. Most patients return to normal activities in 3–6 months, though it may take longer for athletes or those involved in physically demanding work.

Possible Risks or Side Effects (Complications)

The potential complications include:

• Infection: A common risk with any surgical procedure.

• Nerve or Blood Vessel Injury: There is a small risk of injury to nearby nerves or blood vessels during surgery.

• Delayed Healing or Nonunion: The fracture may take longer to heal than expected or fail to heal completely.

• Post-Surgical Instability: In rare cases, the ankle may remain unstable after surgery.

Prognosis (Long-Term Outlook)

The long-term prognosis for patients undergoing arthroscopically assisted surgery for ankle fractures is generally positive, with most patients experiencing good functional recovery. The risk of long-term complications, such as arthritis or instability, can be minimized with proper rehabilitation and adherence to post-surgical care.

Out-of-Pocket Costs for Ankle Fracture Treatment

Medicare

CPT Code 27814 – Open Reduction and Internal Fixation (ORIF) of Ankle Fracture: $181.03

CPT Code 27822 – Open Reduction and Internal Fixation (ORIF) of Ankle Fracture with Multiple Fragments: $205.99

CPT Code 27823 – Open Reduction and Internal Fixation (ORIF) of Ankle Fracture with Involvement of the Tibia or Fibula: $232.00

Medicare Part B typically covers 80% of the approved cost for these procedures once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans, such as Medigap, AARP, or Blue Cross Blue Shield, typically cover the remaining 20%, reducing or eliminating out-of-pocket expenses for Medicare-approved procedures. These plans are designed to work in coordination with Medicare to fill the coverage gap.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans usually cover any remaining costs, including coinsurance or small deductibles, which generally range from $100 to $300 depending on your plan and provider network.

Workers’ Compensation

If your ankle fracture is related to a work-related injury, Workers’ Compensation will cover all medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier covers all costs directly.

No-Fault Insurance

If your ankle fracture occurred due to an automobile accident, No-Fault Insurance will typically cover the full cost of your treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment based on your policy terms.

Example

Mark Stevens suffered an ankle fracture after a fall and required open reduction and internal fixation (ORIF). The estimated Medicare out-of-pocket cost for his CPT 27814 procedure was $181.03. Because Mark had supplemental coverage through Blue Cross Blue Shield, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the surgery.

Frequently Asked Questions (FAQ)

What is Arthroscopically Assisted Surgery for Ankle Fractures?
Arthroscopically assisted surgery for ankle fractures is a minimally invasive technique that uses small incisions and a camera to visualize and treat fractures, particularly those that may involve additional injuries like cartilage damage or ligament tears.

What are the benefits of arthroscopy in treating ankle fractures?
Arthroscopy offers enhanced visualization, allowing for more precise fracture reduction and the detection of hidden injuries. It also reduces soft tissue damage and speeds up recovery compared to traditional open surgery.

How is arthroscopically assisted surgery different from traditional surgery?
Arthroscopically assisted surgery uses smaller incisions and specialized instruments to view and treat the fracture, reducing recovery time and minimizing scarring. Traditional surgery involves larger incisions and may have a longer recovery period.

How do I prepare for surgery?
Preparation includes a physical exam, imaging studies, and discussions regarding your medical history. You may need to stop smoking and maintain a healthy weight to promote healing.

What is the recovery process like?
Recovery includes wearing a cast or boot to immobilize the ankle, gradually increasing weight-bearing, and engaging in physical therapy to restore strength and flexibility. Most patients can return to normal activities within 3–6 months.

What are the risks of arthroscopically assisted surgery for ankle fractures?
Potential risks include infection, nerve injury, delayed healing, or post-surgical instability. However, the minimally invasive nature of the procedure reduces the risk of many complications.

How long will it take to recover from arthroscopically assisted surgery?
Most patients recover within 3–6 months, but athletes or individuals in physically demanding jobs may take longer to return to their normal activities.

Summary and Takeaway

Arthroscopically assisted surgery for ankle fractures is an effective option that provides enhanced visualization, reduced recovery times, and the ability to detect and treat hidden injuries. It offers significant advantages over traditional open surgery, and outcomes are generally excellent with proper rehabilitation.

Clinical Insight & Recent Findings

A recent systematic review and meta-analysis compared arthroscopically assisted internal fixation (ARIF) with traditional open reduction and internal fixation (ORIF) for ankle fractures. Reviewing 10 studies with 755 patients, researchers found that ARIF provided better functional outcomes and lower pain scores than ORIF, without increasing surgical time or complication rates. 

Arthroscopy also revealed a high rate of hidden injuries such as cartilage damage, ligament tears, and loose bodies—issues that might otherwise go untreated. These findings support ARIF as a valuable adjunct to fracture surgery, offering improved precision, detection of associated injuries, and enhanced recovery potential. (“Study shows arthroscopy with ankle fracture surgery improves recovery – see PubMed”)

Who Performs This Surgery? (Specialists and Team Involved)

Arthroscopically assisted surgery for ankle fractures is typically performed by orthopedic surgeons specializing in foot and ankle surgery. The surgical team also includes anesthesiologists, nurses, and physical therapists to assist in preoperative, intraoperative, and postoperative care.

When to See a Specialist?

You should see a foot and ankle specialist if you experience significant pain, swelling, or difficulty moving your ankle after an injury. If non-surgical treatments fail, surgery may be necessary.

When to Go to the Emergency Room?

Seek emergency care if you experience sudden, severe pain, swelling, or instability in the ankle after an injury. This could indicate a fracture or other serious injury requiring immediate attention.

What Recovery Really Looks Like?

Recovery varies, but most patients can return to light activities within 3 to 6 months. Full recovery, including return to high-impact activities, typically occurs within 12 months.

What Happens If You Delay Surgery?

Delaying surgery can lead to worsening fracture misalignment, increased pain, and limited mobility. Early surgical intervention can help prevent long-term complications and improve outcomes.

How to Prevent Recurrence or Failure?

Follow all post-surgical instructions, engage in physical therapy, and wear the recommended footwear to prevent future injuries and ensure a successful recovery.

Nutrition and Bone or Joint Health

A diet rich in protein, calcium, and vitamin D supports bone healing after surgery. Maintaining overall health is key to a successful recovery.

Activity and Lifestyle Modifications

Engage in low-impact activities such as swimming or cycling during recovery. Avoid high-impact activities until cleared by your surgeon. Regular stretching and strengthening exercises will help maintain joint health.

Do you have more questions?