Summary

For chronic pain after healed ankle fracture, arthroscopic treatment with hardware removal is a better treatment option than hardware removal and conservative treatment.

Abstract

Purpose

The purpose of this prospective study was to evaluate the effectiveness of arthroscopy combined with hardware removal for chronic pain after satisfactory healing of ankle fractures. We hypothesized that combining hardware removal with arthroscopy for the intra-articular pathology would improve residual complaints more versus the hardware removal alone.

Methods

The last 12 years, the outcomes of 120 patients (61 female-59 male) of mean age 37,2y (Group A) and 33,3y (Group B), with chronic pain after healed ankle fracture treated with two different therapeutic plans, by two different Surgeon Groups were prospectively studied. In Group A, it was performed hardware removal with conservative treatment and in Group B, arthroscopic intervention with hardware removal. Patients were reviewed preoperatively and 6 and 12 months postoperatively using ROM, VAS, American Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI).

Results

Median ROM improved significant from 51,6 (45-60) points to 60 (55-65) points in group A and also from 52,2 (45-60) points to 63,1 (55-65) points in group B, and this improvement was significantly higher for patients in group B (MWU test: z-score is -4.83; significant at p <0.05). Median VAS scores improved significant from 2,87 (2-4) points to 0,48 (0-1) points in group A and from 2,72 (2-4) points to 0,28 (0-1) points in group B, and this improvement was not significant between two groups (MWU test: z-score 1.89 / not significant at p <0.05). Median AOFAS scores improved significantly from 85,4 (77-95) points to 94,2 (83-100) points in group A and from 83,9 (77-91) points to 97,6 (94-100) points in group B, and this improvement was significantly higher for patients in group B (MWU test: z-score -4.47; significant at p <0.05). Median FADI scores improved significantly from 86,7 (76,9-90,4) points to 95,4 (91,3-99) points in group A and from 86,3 (76,9-90,4) points to 97,2 (91,3-100) points in group B, and this improvement was also significantly higher for patients in group B (MWU test: z-score -4.47; significant at p <0.05).

Conclusions

This study supports the conception that when there is a definite diagnosis such as loose body, bony impingement, cartilage defect or anterolateral or anteromedial soft-tissue impingement causing chronic pain after healed ankle fracture, arthroscopic treatment with hardware removal is a better treatment option than hardware removal and conservative treatment.