Miksch Rainer Christoph, Spindler Fabian Tobias, Böcker Wolfgang, Polzer Hans, Baumbach Sebastian Felix
LMU Klinikum, Munich, Germany.
Arch Orthop Trauma Surg. 2025 Sep 18;145(1):451. doi: 10.1007/s00402-025-06030-4.
Ankle fractures often involve intra-articular pathologies, which can only be addressed by additional arthroscopy. This systematic review aims to compare the outcomes of arthroscopically assisted open reduction and internal fixation (AORIF) with traditional open reduction and internal fixation (ORIF) for ankle fractures.
A systematic literature search adhering to PICOS and PRISMA guidelines was conducted across the following databases: MEDLINE (PubMed), Scopus, Central and EMBASE. Studies that compared AORIF and ORIF of ankle fractures and focused on patient-reported outcome measures (PROMs) as the primary outcome were included. Excluded were studies on non-acute or non-isolated fractures, pilon fractures, concomitant injuries outside the ankle, biomechanical or computational studies, and those lacking objective outcome data.
A total of 7089 studies were screened, 12 of which met the inclusion criteria for qualitative synthesis. The level of evidence was I-III with a mean MINORS Tool score of 19.17. Among the included studies, six studies focused on unimalleolar fractures, with four demonstrating significantly better PROMs for the AORIF group. Five studies addressed bimalleolar and/or trimalleolar fractures, with one showing significantly better PROMs for AORIF. Seven studies reported on intra-articular pathologies, with a detection rate of up to 88.89%. Two out of three studies on posttraumatic arthritis indicated lower grades of osteoarthritis in the AORIF group.
The review suggests that AORIF may lead to improved scores as obtained through various PROMs compared to ORIF, particularly for unimalleolar fractures. However, the heterogeneity among the underlying studies indicates the need for further research to identify specific patient populations and fracture types that would benefit the most from AORIF.
The online version contains supplementary material available at 10.1007/s00402-025-06030-4.
踝关节骨折常涉及关节内病变，这只能通过额外的关节镜检查来处理。本系统评价旨在比较关节镜辅助切开复位内固定术（AORIF）与传统切开复位内固定术（ORIF）治疗踝关节骨折的疗效。
按照PICOS和PRISMA指南，在以下数据库中进行系统的文献检索：MEDLINE（PubMed）、Scopus、CENTRAL和EMBASE。纳入比较踝关节骨折AORIF和ORIF并将患者报告结局指标（PROMs）作为主要结局的研究。排除关于非急性或非孤立性骨折、pilon骨折、踝关节以外的合并伤、生物力学或计算研究以及缺乏客观结局数据的研究。
共筛选7089项研究，其中12项符合定性综合分析的纳入标准。证据水平为I - III级，MINORS工具评分平均为19.17。在纳入的研究中，6项研究聚焦于单踝骨折，其中4项显示AORIF组的PROMs明显更好。5项研究涉及双踝和/或三踝骨折，其中1项显示AORIF的PROMs明显更好。7项研究报告了关节内病变，检出率高达88.89%。三项关于创伤后关节炎的研究中有两项表明AORIF组的骨关节炎等级较低。
该评价表明，与ORIF相比，AORIF可能会使通过各种PROMs获得的评分有所提高，尤其是对于单踝骨折。然而，基础研究之间的异质性表明需要进一步研究，以确定最能从AORIF中获益的特定患者群体和骨折类型。
在线版本包含可在10.1007/s00402 - 025 - 06030 - 4获取的补充材料。
