Arthroscopy-Assisted Open Reduction Internal Fixation Versus Conventional Open Reduction Internal Fixation in the Treatment of Ankle Fractures: A Systematic Review With Meta-Analysis

Background: Arthroscopy can be used to assist the open reduction internal fixation (ORIF) approach in the treatment of acute ankle fractures. Arthroscopy can also help to assess the articular surface but is performed in only 1% of ankle fracture cases. Purpose: We aimed to investigate (1) whether arthroscopy-assisted ORIF (AORIF) would lead to improved postoperative functional outcomes compared to conventional ORIF and (2) whether differences in postoperative complication rates exist between these 2 techniques. Methods: A systematic review was performed; 2 researchers independently searched the online databases of PubMed, Scopus, Embase, Cochrane, and Google Scholar. All studies that directly investigated the outcomes of AORIF versus conventional ORIF in the treatment of ankle fractures and contained quantitative data were eligible for inclusion. The Cochrane tools for bias assessment were applied independently by 2 researchers. Results: Six articles (2 randomized controlled trials and 4 retrospective cohort studies) were included in this systematic review. The meta-analysis of functional outcome scores resulted in a standardized mean difference of 0.6 (confidence interval [CI]: [0.3, 0.9]) favoring AORIF, after excluding 2 studies due to missing standard deviations. The overall complication rate was similar between the 2 groups, with a pooled odds ratio of 1.1 (CI: [0.4, 3.0]). Conclusion: The findings of this systematic review and meta-analysis suggest that AORIF might improve postoperative outcomes without increasing the complication rate when compared to conventional ORIF. However, due to the inherent clinical heterogeneity of the included studies, further well-designed randomized controlled trials are required.